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.

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

Centro de Investigación Biomédica en Red en enfermedades respiratorias Barcelona Spain

Department of Anesthesia Intensive Care and Emergency Medicine Fondazione Policlinico Universitario A Gemelli IRCCS 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 Ghent University Hospital Ghent Belgium

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

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

Department of Public Health Sciences Penn State University College of Medicine Hershey PA USA

Division of Pulmonary and Critical Care Medicine Mayo Clinic Rochester MN USA

Division of Pulmonary and Critical Care Medicine Penn State Health Milton S Hershey Medical Center Hershey PA USA

Medical Intensive Care Unit APHP Hôpital Saint Louis Famirea Study Group ECSTRA team and Clinical Epidemiology UMR 1153 Center of Epidemiology and Biostatistics Sorbonne Paris Cité CRESS INSERM Paris Diderot Sorbonne University Paris France

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

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