OBJECTIVE: Intensive Care Units (ICU) acquired Pneumonia (ICU-AP) is one of the most frequent nosocomial infections in critically ill patients. Our aim was to determine the effects of having an ICU-AP in immunosuppressed patients with acute hypoxemic respiratory failure. DESIGN: Post-hoc analysis of a multinational, prospective cohort study in 16 countries. SETTINGS: ICU. PATIENTS: Immunosuppressed patients with acute hypoxemic respiratory failure. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: The original cohort had 1611 and in this post-hoc analysis a total of 1512 patients with available data on hospital mortality and occurrence of ICU-AP were included. ICU-AP occurred in 158 patients (10.4%). Hospital mortality was higher in patients with ICU-AP (14.8% vs. 7.1% p < 0.001). After adjustment for confounders and centre effect, use of vasopressors (Odds Ratio (OR) 2.22; 95%CI 1.46-3.39) and invasive mechanical ventilation at day 1 (OR 2.12 vs. high flow oxygen; 95%CI 1.07-4.20) were associated with increased risk of ICU-AP while female gender (OR 0.63; 95%CI 0.43-94) and chronic kidney disease (OR 0.43; 95%CI 0.22-0.88) were associated with decreased risk of ICU-AP. After adjustment for confounders and centre effect, ICU-AP was independently associated with mortality (Hazard Ratio 1.48; 95%CI 14.-1.91; P = 0.003). CONCLUSIONS: The attributable mortality of ICU-AP has been repetitively questioned in immunosuppressed patients with acute respiratory failure. This manuscript found that ICU-AP represents an independent risk factor for hospital mortality.

AP HP Groupe Hospitalier Pitié Salpêtrière Charles Foix Service de Pneumologie Médecine Intensive et Réanimation Département R3S Sorbonne Université INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France

CIBERES Universitat Autonòma de Barcelona European Study Group of Infections in Critically Ill Patients Barcelona Spain

Critical Care Center CHU Lille School of Medicine University of Lille Lille France

Department of Anesthesia Intensive Care and Emergency Medicine Fondazione Ospedale Universitario A Gemelli IRCCS Italy; Istituto di Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore Rome Italy

Department of Anesthesiology and Intensive Care 1st Faculty of Medicine and General University Hospital Charles University Prague Czech Republic

Department of Critical Care and Graduate Program in Translational Medicine D'Or Institute for Research and Education Programa de Pós Graduação em Clínica Médica Rio De Janeiro Brazil

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 Hôpital Erasme Université Libre de Bruxelles Brussels Belgium

Department of Intensive Care Medicine Multidisciplinary Intensive Care Research Organization and Department of Clinical Medicine Trinity College Wellcome Trust HRB Clinical Research Facility St James Hospital Dublin Ireland; Hospital de Barcelona IDIBAPS CIBERes Barcelona Spain

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 Medicine and Interdepartmental Division of Critical Care Medicine Sinai Health System University of Toronto Toronto ON Canada

Division of Intensive Care Medicine Department of Anesthesiology Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland

Division of Pulmonary and Critical Care Penn State University College of Medicine Hershey PA USA

Medical Intensive Care Unit APHP Hôpital Saint Louis Famirea Study Group ECSTRA Team and Clinical Epidemiology UMR 1153 Center of Epidemiology France

Medical Intensive Care Unit Hôtel Dieu HME University Hospital of Nantes Nantes France

Pulmonary and Critical Care Medicine Mayo Clinic Rochester MN USA

Réanimation Polyvalente et Département d'Anesthésie et de Réanimation Institut Paoli Calmettes Marseille France

Terapia Intensiva Hospital Maciel Montevideo Uruguay

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