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Multicenter Study
. 2025 May 1;53(5):e1080-e1094.
doi: 10.1097/CCM.0000000000006615. Epub 2025 Feb 21.

Association Between Type of Immunosuppression and the Incidence, Microbiology, and Outcomes of Bacterial Ventilator-Associated Lower Respiratory Tract Infections: A Retrospective Multicenter Study

Louis Kreitmann  1   2 , Constance Bayon  3 , Ignacio Martin-Loeches  4   5 , Pedro Póvoa  6   7   8 , Jorge Salluh  9   10 , Anahita Rouzé  3   11 , Anne-Sophie Moreau  3 , Alain Duhamel  12 , Julien Labreuche  12 , Saad Nseir  3   11 ; Type of iMmunosuppression and the Incidence, Microbiology, and OutcomeS of ventilator-Associated lower respiratory tract infections (MIMOSA) Study Group
Collaborators, Affiliations
Multicenter Study

Association Between Type of Immunosuppression and the Incidence, Microbiology, and Outcomes of Bacterial Ventilator-Associated Lower Respiratory Tract Infections: A Retrospective Multicenter Study

Louis Kreitmann et al. Crit Care Med. .

Abstract

Objectives: Ventilator-associated lower respiratory tract infections (VALRTIs) are among the most common ICU-acquired infections in patients receiving invasive mechanical ventilation (IMV). Immunocompromised patients may have a lower incidence of VALRTI when compared with nonimmunocompromised patients, but the influence of the type of immunosuppression on the epidemiology of VALRTI has not been investigated. The study objectives were to assess the association of the type of immunosuppression with the incidence, microbiology, and outcomes (ICU mortality, ICU length of stay, and duration of IMV) of VALRTI related to bacterial pathogens.

Design: Multicenter, international retrospective cohort study.

Setting: One hundred eighteen ICUs (118) in nine countries.

Patients: Eight hundred fifty-four immunocompromised adult patients (median age, 65 yr; 57.6% males) requiring IMV for greater than 48 hours, including 162 with hematologic malignancies.

Interventions: None.

Measurements and main results: Patients with hematologic malignancies had a lower 28-day cumulative incidence of bacterial VALRTI than patients with other types of immunosuppression (13.6% vs. 20.1%; adjusted cause-specific hazard ratio, 0.61; 95% CI, 0.37-0.97), mostly due to a lower incidence of ventilator-associated pneumonia (9.3% vs. 13.9%). The proportion of VALRTI cases related to multidrug-resistant bacteria was similar between groups. Occurrence of bacterial VALRTI was associated with an increased mortality and a longer ICU length of stay, but this effect was independent of the type of immunosuppression.

Conclusions: Patients with hematologic malignancies had a lower 28-day cumulative incidence of bacterial VALRTI than patients with other types of immunosuppression, mainly due to a lower incidence of ventilator-associated pneumonia.

Trial registration: ClinicalTrials.gov NCT04359693.

Keywords: cohort study; cross-infection; intensive care unit; ventilator-associated lower respiratory tract infection; ventilator-associated pneumonia; ventilator-associated tracheobronchitis.

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Conflict of interest statement

Dr. Kreitmann’s institution received funding from BioMérieux and has been employed by Transgene. Drs. Póvoa, Rouzé, and Nseir received funding form Gilead and MSD. Dr. Rouzé received funding from Mundipharma. Dr. Nseir received funding from Pfizer, BioMérieux, Fisher and Paykel, and BioRad. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Magill SS, O’Leary E, Janelle SJ, et al.; Emerging Infections Program Hospital Prevalence Survey Team: Changes in prevalence of health care–associated infections in U.S. hospitals. N Engl J Med. 2018; 379:1732–1744
    1. Nseir S, Ader F, Marquette C-H: Nosocomial tracheobronchitis. Curr Opin Infect Dis. 2009; 22:148–153
    1. Papazian L, Klompas M, Luyt C-E: Ventilator-associated pneumonia in adults: A narrative review. Intensive Care Med. 2020; 46:888–906
    1. Kreitmann L, Gaudet A, Nseir S: Ventilator-associated pneumonia in immunosuppressed patients. Antibiotics. 2023; 12:413
    1. Martin-Loeches I, Povoa P, Rodríguez A, et al.; TAVeM study: Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): A multicentre, prospective, observational study. Lancet Respir Med. 2015; 3:859–868

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