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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2013 November;79(11):1217-28
Comparison of acquisition of resistant microorganisms and infections in critically-ill patients with and without malignancies
Rinaudo M. 1, Cobos-Trigueros N. 2, Solé M. 3, Castro P. 1, Hernández C. 1, 2¸ Nicolás J. M. 1, Vila J. 3, Morata L. 2, Pumarol J. 1, Soriano A. 2, Mensa J. 2, Martínez J. A. 2 ✉
1 Medical Intensive Care Unit, Hospital Clínic-IDIBAPS, Barcelona Centre for International Health Research (CRESIB, Universitat de Barcelona), Barcelona, Spain;
2 Department of Infectious Diseases, Hospital Clínic-IDIBAPS, Barcelona Centre for International Health Research (CRESIB, Universitat de Barcelona), Barcelona, Spain;
3 Department of Clinical Microbiology, Hospital Clínic-IDIBAPS- Barcelona Centre for International Health Research (CRESIB, Universitat de Barcelona), Barcelona, Spain
Background: Patients with malignancies are often considered at risk of acquiring infections by resistant or potentially resistant microorganisms (RPRMs). However, data supporting this contention is scarce. We have compared critically ill patients with haematological malignancies (HM), solid tumours (ST) and without cancer (NC) in terms of acquisition of RPRMs, infections and mortality.
Methods: Observational, prospective cohort study of patients admitted to a medical intensive care unit (ICU). Swabbing of nares, pharynx and rectum, and culture of respiratory secretions were obtained within 48 h of admission and thrice weekly thereafter. Clinical samples were obtained as deemed necessary by the attending physician. Clinical variables, severity scores on admission and exposures during ICU stay were also collected. Multivariable logistic regression analysis was used to evaluate ICU mortality.
Results: Out of 969 included patients 127 (13.1%) had HM and 93 (9.6%) had ST. Patients with malignancies were more frequently exposed to central venous catheterization, methylprednisolone, and any antipseudomonal antibiotic whereas they were less commonly exposed to invasive mechanical ventilation. Patients with HM were more often admitted with an infection. There were no differences among groups in terms of RPRMs acquisition during ICU stay or prevalence of ICU-acquired infections due to any microorganism, including RPRMs. Having a HM was an independent predictor of mortality regardless of APACHE II score.
Conclusion: Critically ill cancer patients did not show a higher rate of RPRMs acquisition nor ICU-acquired infections. Mortality was higher in the HM group and it was not accurately predicted on admission by APACHE II score.