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Bacteremia in critically ill immunocompromised patients with acute hypoxic respiratory failure: A post-hoc analysis of a prospective multicenter multinational cohort
A. Van de Louw, J. Rello, I. Martin-Loeches, D. Mokart, V. Metaxa, D. Benoit, A. Barratt-Due, M. Soares, P. Pickkers, M. Antonelli, A. Demoule, P. Schellongowski, A. Kouatchet, S. Mehta, M. Balik, PR. Bauer, V. Lemiale, V. Walter, E. Azoulay,...
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, multicentrická studie
NLK
ProQuest Central
od 2003-03-01 do Před 2 měsíci
Nursing & Allied Health Database (ProQuest)
od 2003-03-01 do Před 2 měsíci
Health & Medicine (ProQuest)
od 2003-03-01 do Před 2 měsíci
- MeSH
- bakteriemie * epidemiologie MeSH
- imunokompromitovaný pacient MeSH
- jednotky intenzivní péče MeSH
- kritický stav MeSH
- lidé MeSH
- prospektivní studie MeSH
- respirační insuficience * epidemiologie MeSH
- syndrom dechové tísně * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
PURPOSE: The characteristics and impact of bacteremia have not been widely investigated in immunocompromised patients with acute respiratory failure (ARF). METHODS: We performed a secondary analysis of a prospective cohort of immunocompromised patients with ARF (EFRAIM study). After exclusion of blood cultures positive for coagulase negative Staphylococci, we compared patients with (n = 236) and without (n = 1127) bacteremia. RESULTS: The incidence of bacteremia was 17%. Bacterial pneumonia and extra-pulmonary ARDS were the main causes of ARF in bacteremic patients. Bacteremia involved gram negative rods (48%), gram positive cocci (40%) or were polymicrobial (10%). Bacteremic patients had more hematological malignancy, higher SOFA scores and increased organ support within 7 days. Bacteremia was associated with higher crude ICU mortality (40% versus 32%, p = 0.02), but neither hospital (49% versus 44%, p = 0.17) nor 90-day mortality (60% versus 56%, p = 0.25) were different from non-bacteremic patients. After propensity score matching based on baseline characteristics, the difference in ICU mortality lost statistical significance (p = 0.06), including in a sensitivity analysis restricted to patients with pneumonia. CONCLUSIONS: We analyzed a large population of immunocompromised patients with ARF and an incidence of bacteremia of 17%. We could not demonstrate an impact of bacteremia on mortality after adjusting for baseline characteristics.
Department of Critical Care King's College Hospital NHS Foundation Trust London SE5 9RS UK
Department of Emergencies and Critical Care Oslo University Hospital Oslo Norway
Department of Intensive Care Ghent University Hospital Ghent Belgium
Department of Intensive Care Medicine Radboud University Medical Center Nijmegen the Netherlands
Department of Medical Intensive Care Medicine University Hospital of Angers Angers France
Department of Medicine 1 Medical University of Vienna Vienna Austria
Department of Public Health Sciences Penn State University College of Medicine Hershey PA USA
Department of Respiratory Medicine Hospital Clinic IDIBAPS CIBERes Barcelona Spain
Division of Pulmonary and Critical Care Medicine Mayo Clinic Rochester MN USA
Infectious Area Vall d'Hebron Institute of Research Barcelona Spain
Citace poskytuje Crossref.org
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- $a PURPOSE: The characteristics and impact of bacteremia have not been widely investigated in immunocompromised patients with acute respiratory failure (ARF). METHODS: We performed a secondary analysis of a prospective cohort of immunocompromised patients with ARF (EFRAIM study). After exclusion of blood cultures positive for coagulase negative Staphylococci, we compared patients with (n = 236) and without (n = 1127) bacteremia. RESULTS: The incidence of bacteremia was 17%. Bacterial pneumonia and extra-pulmonary ARDS were the main causes of ARF in bacteremic patients. Bacteremia involved gram negative rods (48%), gram positive cocci (40%) or were polymicrobial (10%). Bacteremic patients had more hematological malignancy, higher SOFA scores and increased organ support within 7 days. Bacteremia was associated with higher crude ICU mortality (40% versus 32%, p = 0.02), but neither hospital (49% versus 44%, p = 0.17) nor 90-day mortality (60% versus 56%, p = 0.25) were different from non-bacteremic patients. After propensity score matching based on baseline characteristics, the difference in ICU mortality lost statistical significance (p = 0.06), including in a sensitivity analysis restricted to patients with pneumonia. CONCLUSIONS: We analyzed a large population of immunocompromised patients with ARF and an incidence of bacteremia of 17%. We could not demonstrate an impact of bacteremia on mortality after adjusting for baseline characteristics.
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