08 Jun Treatment with appropriate antibiotics improves the outcome of immunosuppressed patients with lung infection associated with mechanical ventilation
Posted at 12:02h
⇒ The INCLIVA Anesthesia Research Group participates in an international study on the incidence of lung infection associated with mechanical ventilation in immunosuppressed patients.
⇒ The results of the multicentre trial have been published in the European Respiratory Journal (ERJ).
Lower respiratory tract infections associated with the mechanical ventilation ventilator include both tracheobronchitis and ventilator-associated pneumonia, the most common infectious complication in the Intensive Care Unit (ICU). The main objective of the study was to determine the incidence of respirator-associated lower respiratory tract infections by comparing immunosuppressed and non-immunosuppressed patients. The aetiology and impact on outcome (length of ICU and hospital stay, days on mechanical ventilation and mortality) and the effect of appropriate antibiotic treatment were also studied.
The TAVeM study is the largest international multicenter observational study of respiratory tract infections associated with the ventilator, in which 114 Intensive Care Units in Europe and Latin America have collaborated. All patients who received mechanical ventilation for more than 48 hours in the ICU were included. More than 2,900 patients participated in the study, and immunosuppressed patients were compared with non-immunosuppressed patients or control group.
As Gerardo Aguilar
MD PhD, researcher at INCLIVA and anesthesiologist at the Hospital Clínico Universitario de Valencia explained: «This is the first study on this particular population, no study to date has specifically evaluated respirator-associated lower respiratory tract infections to determine the incidence, etiology and outcome of these infections in immunosuppressed patients, and to establish whether these factors are different in patients without apparent immunosuppression. We believe our results are robust and may be useful for future research»
Among patients with lower respiratory tract infection, the death rate in ICU was higher in immunosuppressed patients. Mortality was higher for pneumonias in both groups. In addition, in both groups, lower respiratory tract infection was associated with longer duration of mechanical ventilation and ICU stay. Also, appropriate antibiotic treatment was shown to be a protective factor for mortality risk. Therefore, early use of appropriate antibiotic treatment for tracheobronchitis in immunosuppressed patients may be beneficial in reducing the transition from tracheobronchitis to ventilator-associated pneumonia and improving patient outcomes, according to the results of the TAVeM study.
In conclusion, the study suggests that the incidence of respirator-associated lower respiratory tract infections is lower among immunosuppressed patients than among control patients. These infections are most often caused by resistance to many drugs in this population, and are associated with increased mortality. These results suggest that pretreatment with antibiotics should be better adapted in immunosuppressed patients to reduce the incidence of infections. More studies are needed to better determine the relationship between the type of immunosuppression and the risk of lower respiratory tract infection associated with the ventilator.
About immunosuppressed patients
Immunosuppressed patients have an immune system that functions below normal, because of their underlying disease, they have one or more defense mechanisms altered. Surgical interventions for transplants, HIV patients or medical treatments such as chemotherapy and radiotherapy are some of the causes of immunosuppression. This group of patients has a particularly poor outcome in the ICU, due to an increased risk of infection (especially opportunistic pathogens), increased severity of disease and immunosuppression itself. They often receive broad-spectrum antibiotic treatment, which increases the risk of developing multi-drug resistant bacteria. The main cause of admission to the ICU for these patients is acute respiratory failure. Although its results have improved substantially in recent years, the prognosis remains unfavourable, with hospital mortality rates of up to 60% in mechanically ventilated patients. However, to date, no studies have specifically evaluated lower respiratory tract infections in this population.
Access to the scientific paper:
Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections. Moreau AS et al. TAVeM Study Group. Eur Respir J 2018.