• Andry Van de Louw, Jordi Rello, Ignacio Martin-Loeches, Djamel Mokart, Victoria Metaxa, Dominique Benoit, Andreas Barratt-Due, Marcio Soares, Peter Pickkers, Massimo Antonelli, Alexandre Demoule, Peter Schellongowski, Achille Kouatchet, Sangeeta Mehta, Martin Balik, Philippe R Bauer, Virginie Lemiale, Vonn Walter, Elie Azoulay, and EFRAIM investigators and the Nine-I study group.
• Division of Pulmonary and Critical Care Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA. Electronic address: avandelouw@pennstatehealth.psu.edu.
• J Crit Care. 2021 Aug 1; 64: 114-119.

PurposeThe characteristics and impact of bacteremia have not been widely investigated in immunocompromised patients with acute respiratory failure (ARF).MethodsWe performed a secondary analysis of a prospective cohort of immunocompromised patients with ARF (EFRAIM study). After exclusion of blood cultures positive for coagulase negative Staphylococci, we compared patients with (n = 236) and without (n = 1127) bacteremia.ResultsThe incidence of bacteremia was 17%. Bacterial pneumonia and extra-pulmonary ARDS were the main causes of ARF in bacteremic patients. Bacteremia involved gram negative rods (48%), gram positive cocci (40%) or were polymicrobial (10%). Bacteremic patients had more hematological malignancy, higher SOFA scores and increased organ support within 7 days. Bacteremia was associated with higher crude ICU mortality (40% versus 32%, p = 0.02), but neither hospital (49% versus 44%, p = 0.17) nor 90-day mortality (60% versus 56%, p = 0.25) were different from non-bacteremic patients. After propensity score matching based on baseline characteristics, the difference in ICU mortality lost statistical significance (p = 0.06), including in a sensitivity analysis restricted to patients with pneumonia.ConclusionsWe analyzed a large population of immunocompromised patients with ARF and an incidence of bacteremia of 17%. We could not demonstrate an impact of bacteremia on mortality after adjusting for baseline characteristics.Copyright © 2021 Elsevier Inc. All rights reserved.

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