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Ventilator-associated pneumonia and bloodstream infections in intensive care unit cancer patients: a retrospective 12-year study on 3388 prospectively monitored patients

  • A. StoclinEmail author
  • F. Rotolo
  • Y. Hicheri
  • M. Mons
  • E. Chachaty
  • B. Gachot
  • J.-P. Pignon
  • M. Wartelle
  • F. Blot
Original Article
  • 27 Downloads

Abstract

Purpose

Some publications suggest high rates of healthcare-associated infections (HAIs) and of nosocomial pneumonia portending a poor prognosis in ICU cancer patients. A better understanding of the epidemiology of HAIs in these patients is needed.

Methods

A retrospective analysis of all the patients hospitalized for ≥ 48 h during a 12-year period in the 12-bed ICU of the Gustave Roussy hospital, monitored prospectively for ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) and for use of medical devices.

Results

During 3388 first stays in the ICU, 198 cases of VAP and 103 primary, 213 secondary, and 77 catheter-related BSIs were recorded. The VAP rate was 24.5/1000 ventilator days (95% confidence interval [CI] 21.2–28.0); the catheter-related BSI rate was 2.3/1000 catheter days (95% CI 1.8–2.8). The cumulative incidence during the first 25 days of exposure was 58.8% (95% CI 49.1–66.6%) for VAP, 8.9% (95% CI, 6.2–11.5%) for primary, 15.1% (95% CI 11.6–18.5%) for secondary and 5.0% (95% CI 3.2–6.8%) for catheter-related BSIs. VAP or BSIs were not associated with a higher risk of ICU mortality.

Conclusions

This is the first study to report HAI rates in a large cohort of critically ill cancer patients. Although both the incidence of VAP and the rate of BSI are higher than in general ICU populations, this does not impact patient outcomes. The occurrence of device-associated infections is essentially due to severe medical conditions in patients and to the characteristics of malignancy.

Keywords

Healthcare-associated infections Intensive care unit Risk factors Catheter-associated infections Ventilator-associated pneumonia 

Notes

Acknowledgments

We thank Monique Monhonval for data entry, Pascale Jan for technical support, and Lorna Saint Ange for editing. AS and FR had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Author contributions

AS and FB contributed to conception and design. AS, MW, and MM were involved in the data acquisition. FR and JPP planned and performed the statistical analyses. All the authors were involved in the interpretation of the results, read, and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

520_2019_4800_MOESM1_ESM.docx (28 kb)
ESM 1 (DOCX 28 kb)
520_2019_4800_MOESM2_ESM.doc (574 kb)
ESM 2 (DOC 574 kb)
520_2019_4800_MOESM3_ESM.docx (32 kb)
Figure S1. Flow chart. Data flow diagram for the study of intensive care unit infections. Only stays lasting at least 48 hours were considered. Only the first stay of each patient was included in the main analyses.*: 3,431 remaining patients because 98 out of the 527 patients with short stays (<48h) had multiple stays. **: 3,388 remaining patients because 43 patients had a short first stay (<48h) and a long second or further stay (≥48h). (DOCX 31 kb)
520_2019_4800_MOESM4_ESM.docx (48 kb)
Figure S2. Number of stays in the Intensive Care Unit (ICU) and their median duration per year. (DOCX 48 kb)
520_2019_4800_MOESM5_ESM.docx (268 kb)
Figure S3. Incidence of ventilator-associated pneumonia and of catheter-related bloodstream infections (BSI) in the Intensive Care Unit at Gustave Roussy Cancer Treatment Center between 2000 and 2011. (DOCX 267 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Service de Médecine Intensive RéanimationGustave RoussyVillejuifFrance
  2. 2.Service de Réanimation Médico-ChirurgicaleGustave RoussyVillejuifFrance
  3. 3.Service de Biostatistique et d’EpidémiologieGustave RoussyVillejuifFrance
  4. 4.INSERM U1018, CESPUniversité Paris-Sud, Université Paris-SaclayVillejuifFrance
  5. 5.Service d’Information MédicaleGustave RoussyVillejuifFrance
  6. 6.Service de Microbiologie MédicaleGustave RoussyVillejuifFrance
  7. 7.Direction du Système d’InformationGustave RoussyVillejuifFrance

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