Ventilator-associated pneumonia and bloodstream infections in intensive care unit cancer patients: a retrospective 12-year study on 3388 prospectively monitored patients
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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.
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.
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.
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.
KeywordsHealthcare-associated infections Intensive care unit Risk factors Catheter-associated infections Ventilator-associated pneumonia
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.
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.
- 1.Jarvis WR, Edwards JR, Culver DH, Hughes JM, Horan T, Emori TG, Banerjee S, Tolson J, Henderson T, Gaynes RP, Martone WJ, National Nosocomial Infections Surveillance System (1991) Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med 91:185S–191SCrossRefGoogle Scholar
- 11.Mokart D, Darmon M, Resche-Rigon M, Lemiale V, Pène F, Mayaux J, Rabbat A, Kouatchet A, Vincent F, Nyunga M, Bruneel F, Lebert C, Perez P, Renault A, Hamidfar R, Jourdain M, Meert AP, Benoit D, Chevret S, Azoulay E (2015) Prognosis of neutropenic patients admitted to the intensive care unit. Intensive Care Med 41:296–303CrossRefGoogle Scholar
- 13.Surveillance des infections nosocomiales en réanimation adulte (2016) Réseau REA-Raisin, France – Résultats 2014. Saint-Maurice : Institut de veille sanitaire. 48 p. http://www.invs.sante.fr/Publications-et-outils/Rapports-et-syntheses/Maladiesinfectieuses/2016/Surveillance-des-infections-nosocomiales-en-reanimation-adulte
- 14.Pronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski LH, Berenholtz SM, Thompson DA, Sinopoli DJ, Cosgrove S, Sexton JB, Marsteller JA, Hyzy RC, Welsh R, Posa P, Schumacher K, Needham D (2010) Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 340:c309CrossRefGoogle Scholar