• Ignacio Martin-Loeches, Michael Darmon, Alexandre Demoule, Massimo Antonelli, Peter Schellongowski, Peter Pickkers, Marcio Soares, Jordi Rello, Philippe Bauer, Andry van de Louw, Virgine Lemiale, David Grimaldi, Martin Balik, Sangeeta Mehta, Ac Kouatchet, Andreas Barratt-Due, Miia Valkonen, Jean Reignier, Victoria Metaxa, Anne Sophie Moreau, Gaston Burghi, Djamel Mokart, Elie Azoulay, and Efraim investigators and the Nine-I study group.
• Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO) and Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland; Hospital de Barcelona, IDIBAPS, CIBERes, Barcelona, Spain. Electronic address: imartinl@tcd.ie.
• J Crit Care. 2021 Jun 1; 63: 243-245.

ObjectiveIntensive Care Units (ICU) acquired Pneumonia (ICU-AP) is one of the most frequent nosocomial infections in critically ill patients. Our aim was to determine the effects of having an ICU-AP in immunosuppressed patients with acute hypoxemic respiratory failure.DesignPost-hoc analysis of a multinational, prospective cohort study in 16 countries.SettingsICU.PatientsImmunosuppressed patients with acute hypoxemic respiratory failure.InterventionNone.Measurements And Main ResultsThe original cohort had 1611 and in this post-hoc analysis a total of 1512 patients with available data on hospital mortality and occurrence of ICU-AP were included. ICU-AP occurred in 158 patients (10.4%). Hospital mortality was higher in patients with ICU-AP (14.8% vs. 7.1% p < 0.001). After adjustment for confounders and centre effect, use of vasopressors (Odds Ratio (OR) 2.22; 95%CI 1.46-3.39) and invasive mechanical ventilation at day 1 (OR 2.12 vs. high flow oxygen; 95%CI 1.07-4.20) were associated with increased risk of ICU-AP while female gender (OR 0.63; 95%CI 0.43-94) and chronic kidney disease (OR 0.43; 95%CI 0.22-0.88) were associated with decreased risk of ICU-AP. After adjustment for confounders and centre effect, ICU-AP was independently associated with mortality (Hazard Ratio 1.48; 95%CI 14.-1.91; P = 0.003).ConclusionsThe attributable mortality of ICU-AP has been repetitively questioned in immunosuppressed patients with acute respiratory failure. This manuscript found that ICU-AP represents an independent risk factor for hospital mortality.Copyright © 2020 Elsevier Inc. All rights reserved.

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