Related Experiment Video
Updated: Aug 15, 2025
Growing a Cystic Fibrosis-Relevant Polymicrobial Biofilm to Probe Community Phenotypes
Published on: April 19, 2024
Relationship between immunosuppression and intensive care unit-acquired colonization and infection related to
Louis Kreitmann1,2, Margot Vasseur1, Sonia Jermoumi1
1Médecine Intensive Réanimation, CHU de Lille, 59000, Lille, France.
Purpose:
The impact of immunosuppression on intensive care unit (ICU)-acquired colonization and infection related to multidrug-resistant (MDR) bacteria (ICU-MDR-col and ICU-MDR-inf, respectively) is unknown.
Methods:
We carried out an observational prospective cohort study in 8 ICUs in France (all with single-bed rooms and similar organizational characteristics). All consecutive patients with an ICU stay > 48 h were included, regardless of immune status, and followed for 28 days. Patients underwent systematic screening for colonization with MDR bacteria upon admission and every week subsequently. Immunosuppression was defined as active cancer or hematologic malignancy, neutropenia, solid-organ transplant, use of steroids or immunosuppressive drugs, human immunodeficiency virus infection and genetic. The primary endpoint was the incidence rate of a composite outcome including ICU-MDR-col and/or ICU-MDR-inf.
Results:
750 patients (65.9% males, median age 65 years) were included, among whom 264 (35.2%) were immunocompromised. Reasons for ICU admission, severity scores and exposure to invasive devices and antibiotics during ICU stay were comparable between groups. After adjustment for center and pre-specified baseline confounders, immunocompromised patients had a lower incidence rate of ICU-MDR-col and/or ICU-MDR-inf (adjusted incidence ratio 0.68, 95% CI 0.52-0.91). When considered separately, the difference was significant for ICU-MDR-col, but not for ICU-MDR-inf. The distribution of MDR bacteria was comparable between groups, with a majority of Enterobacteriacae resistant to third-generation cephalosporins (~ 74%).
Conclusion:
Immunocompromised patients had a significantly lower incidence rate of a composite outcome including ICU-MDR-col and/or ICU-MDR-inf. This finding points to the role of contact precautions and isolation measures, and could have important implications on antibiotic stewardship in this population.
Insights
Immunocompromised patients in intensive care units (ICUs) had a lower incidence of multidrug-resistant (MDR) bacteria colonization and infection. This suggests contact precautions may be effective in reducing ICU-MDR bacteria in this vulnerable population.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Immunology
Background:
- Intensive care units (ICUs) are high-risk environments for multidrug-resistant (MDR) bacteria acquisition.
- The impact of patient immunosuppression on ICU-acquired MDR bacterial colonization and infection remains unclear.
Purpose of the Study:
- To investigate the effect of immunosuppression on the incidence of ICU-acquired colonization and infection with MDR bacteria.
- To compare the rates of ICU-MDR colonization and infection between immunocompromised and immunocompetent patients.
Main Methods:
- An observational prospective cohort study was conducted across 8 French ICUs.
- 750 patients with ICU stays >48 hours were included, with systematic screening for MDR bacteria.
- Immunosuppression was defined by specific clinical criteria (e.g., active cancer, neutropenia, transplant, immunosuppressive drugs).
Main Results:
- 35.2% of included patients were immunocompromised.
- Immunocompromised patients exhibited a significantly lower incidence rate of combined ICU-MDR colonization and/or infection (adjusted incidence ratio 0.68).
- This reduction was significant for colonization but not for infection when analyzed separately.
Conclusions:
- Immunocompromised patients have a lower risk of ICU-acquired MDR bacterial colonization and infection.
- Findings highlight the potential effectiveness of contact precautions and isolation measures in this population.
- Results may inform antibiotic stewardship strategies for immunocompromised patients in ICUs.
More Related Videos
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...
01:26Factors 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...
01:25Immunodeficiency Diseases
There are three main causes of immunodeficiency...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:20Infection
The chain begins with pathogens: bacteria, viruses, fungi, prions, or parasites such as protozoa helminths. These can be present on the skin as transient or resident flora, or they can be acquired from the environment. Identifying and treating the type of infection and...