Infections Acquired in the ICU Among Cancer and Other Immunosuppressed Patients: A Nationwide Cohort Study
Renato Daltro-Oliveira, Silvana Soares dos Santos, Luciana Coelho Sanches, Bianca Ramos Ferronatto, Thiago Gomes Romano, Thiago Costa Lisboa, Adriano José Pereira, Alexandre Biasi Cavalcanti, Bruno Martins Tomazini, Viviane Cordeiro Veiga, Bruno Adler Maccagnan Pinheiro Besen, Antonio Paulo Nassar,Objectives:
To compare the cumulative incidence of ICU-acquired infections (ICU-AIs) across distinct immunosuppression diagnostic categories (solid cancer, hematological cancer, other immunosuppression) and nonimmunosuppressed patients, accounting for competing risks of death and discharge.
Design:
Retrospective cohort study using prospectively collected data.
Setting:
A total of 50 participating ICUs in Brazil.
Patients:
A total of 38,126 adult patients admitted between October 2019 and December 2021 with an ICU stay exceeding 48 hours and no infections diagnosed within the first 48 hours.
Interventions:
None.
Measurements and Main Results:
The primary outcome was the incidence of the first ICU-AI during the ICU stay, evaluated using Fine-Gray subdistribution hazard ratios (sHR). In the multivariable competing-risk analysis, patients with hematological malignancies (sHR, 1.64; 95% CI, 1.01–2.65) and other immunosuppressive conditions (sHR, 1.61; 95% CI, 1.02–2.54) were associated with an increased cumulative incidence of ICU-AI, while solid malignancy was not significantly different from non-immunosuppressed patients (sHR, 0.88; 95% CI, 0.68–1.14).
Conclusions:
Patients with hematological malignancies and other immunosuppressive conditions face a significantly higher risk of ICU-AIs.