The following is a summary of “Immunosuppression at ICU admission is not associated with a higher incidence of ICU-acquired bacterial bloodstream infections: the COCONUT study,” published in the June 2024 issue of Critical Care by Zebian et al.
Immunosuppression is known to increase ICU-acquired infections, but its specific impact on bacterial bloodstream infections (BSI) in the ICU, including types of bacteria and patient outcomes, remains unclear.
Researchers started a retrospective study investigating the association between immunosuppression at ICU admission and ICU-acquired BSI.
They examined adult patients in France admitted to a single ICU for more than 48 hours (January 1st and December 31st, 2020, Lille University affiliation). Patients were classified as immunocompromised if they had active cancer, blood cancers, low white blood cell count, transplants, steroid/immunosuppressant use, HIV, or genetic deficiencies, regardless of their immune status. They compared bacterial BSI development within 28 days of ICU admission between these groups while also investigating bacterial types and patient outcomes.
The result showed 1,313 patients in ICU (67% male, median age 62). Roughly 271 (20.6%) were immunocompromised upon admission. The groups had similar illness severity, use of invasive devices, and prior antibiotic use. The key finding was that the rate of BSI within 28 days (incidence) did not differ between immunocompromised and non-immunocompromised patients, even after accounting for potential influencing factors. Furthermore, the types of bacteria causing these infections and the antibiotic resistance were comparable between the groups, with the majority of gram-negative bacilli (~ 64.1%). Notably, BSI was linked to longer ICU stays and ventilation use but not necessarily higher mortality. Significantly, immune status did not affect the relationship between BSI and the outcomes.
Investigators concluded that immunosuppression at ICU admission wasn’t linked to a higher rate of bacterial BSI.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01314-1
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