Related Experiment Video
Updated: Jul 15, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Relationship between immunosuppression and intensive care unit-acquired multidrug-resistant bacteria: a case-control
Saad Nseir1, Christophe Di Pompeo, Maimouna Diarra
1Intensive Care Unit, Calmette Hospital, University Hospital of Lille, France. s-nseir@chru-lille.fr
Objective:
To determine the relationship between immunosuppression and intensive care unit (ICU)-acquired multidrug-resistant (MDR) bacteria.
Design:
Retrospective case-control study based on prospectively collected data.
Setting:
A 30-bed medical and surgical ICU.
Patients:
All patients hospitalized >48 hrs in the ICU were eligible during a 2-yr period.
Interventions:
Immunosuppression was defined as active solid or hematologic malignancy, leucopenia, or chronic immunosuppressive treatment. MDR bacteria were defined as methicillin-resistant Staphylococcus aureus, ceftazidime- or imipenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and extending spectrum beta-lactamase producing Gram-negative bacilli. MDR bacteria screening (nasal, anal, and axilla swabs and tracheal aspirate in intubated patients) was performed at ICU admission and weekly. Only MDR bacteria isolated >48 hrs after ICU admission were taken into account; duplicates were excluded. Isolation measures were applied in all patients at ICU admission, in patients with MDR bacteria, and in patients with immunosuppression. Immunosuppressed patients (cases) were matched (1:1) with immunocompetent patients (controls) according to all the following criteria: age +/-5 yrs, Simplified Acute Physiology Score II +/-5, duration of ICU stay +/-3 days, and category of admission (medical/surgical). Risk factors for ICU-acquired MDR bacteria were determined using univariate and multivariate analyses.
Measurements And Main Results:
Of 1,065 eligible patients, nine patients were excluded for absence of MDR bacteria screening at ICU admission. One hundred thirty-three (12%) patients were immunosuppressed, and 128 (96%) of them were successfully matched. Mean time between ICU admission and first ICU-acquired MDR bacteria was 12 +/- 9 days. Incidence of MDR bacteria was significantly higher in cases than in controls (22 vs. 12 MDR bacteria/1000 ICU days, p = .004). However, immunosuppression was not independently associated with ICU-acquired MDR bacteria.Multivariate analysis identified prior antibiotic treatment and antibiotic treatment in the ICU as risk factors for ICU-acquired MDR bacteria (odds ratio [95% confidence interval] = 1.9 [1-3.6], p = .003; 11 [1.4-83], p = .02; respectively).
Conclusions:
Immunosuppression is not independently associated with ICU-acquired MDR bacteria. However, infection control measures used in our ICU may have influenced this result.
Insights
Immunosuppression was not independently linked to intensive care unit (ICU)-acquired multidrug-resistant (MDR) bacteria. Prior antibiotic use and ICU antibiotic treatment were identified as key risk factors for MDR bacteria acquisition.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Intensive care unit (ICU)-acquired multidrug-resistant (MDR) bacteria pose a significant threat to patient safety.
- Understanding risk factors for MDR bacteria acquisition is crucial for effective infection control.
Purpose of the Study:
- To investigate the association between immunosuppression and the development of ICU-acquired MDR bacteria.
- To identify independent risk factors for MDR bacteria acquisition in the ICU.
Main Methods:
- Retrospective case-control study utilizing prospectively collected data from a 30-bed medical and surgical ICU.
- Immunosuppression defined by malignancy, leucopenia, or immunosuppressive treatment; MDR bacteria defined by specific resistance profiles.
- Patients were matched based on age, severity of illness, ICU stay duration, and admission category; risk factors analyzed using univariate and multivariate methods.
Main Results:
- The incidence of MDR bacteria was higher in immunosuppressed patients (cases) compared to immunocompetent patients (controls) (22 vs. 12 per 1000 ICU days, p = .004).
- Immunosuppression was not found to be an independent risk factor for ICU-acquired MDR bacteria.
- Prior antibiotic treatment (OR 1.9) and antibiotic treatment within the ICU (OR 11) were identified as significant independent risk factors.
Conclusions:
- Immunosuppression is not independently associated with ICU-acquired MDR bacteria, suggesting other factors play a more significant role.
- Strict infection control measures implemented in the ICU may have mitigated the impact of immunosuppression on MDR bacteria acquisition.
Related Concept Videos
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:25Clinical Significance of Antibiotic Resistance
01:25Immunodeficiency Diseases
There are three main causes of immunodeficiency disorders...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin create...
01:27Cryptococcal Meningitis
01:21Microbiota Modulation by Antibiotics