Nosocomial lower respiratory tract infections in patients with immunosuppression: a cohort study

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  • dc.contributor.author Reyes, Luis F.
  • dc.contributor.author Masclans Enviz, Joan Ramon
  • dc.contributor.author Marin Corral, Judith
  • dc.contributor.author European Network for ICU-Related Respiratory Infections (ENIRRIs) European Respiratory Society-Clinical Research Collaboration Investigators
  • dc.date.accessioned 2025-06-13T07:46:08Z
  • dc.date.available 2025-06-13T07:46:08Z
  • dc.date.issued 2025
  • dc.description.abstract Background: This post-hoc analysis of a multinational, multicenter study aimed to describe and compare clinical characteristics, microbiology, and outcomes between immunosuppressed and non-immunosuppressed patients with nosocomial lower respiratory tract infections (nLRTI). The study utilized data from the European Network for ICU-related Respiratory Infections, including 1,060 adult ICU patients diagnosed with nLRTI. Descriptive statistics were used to compare baseline characteristics and pathogen distribution between groups. A Cox proportional hazards model stratified by immunosuppression status was applied to assess 28-day mortality risk, adjusting for disease severity and key clinical variables. Results: Immunosuppression was observed in 24.9% (264/1060) of the patients, and oncological conditions were the most common etiology of immunosuppression. Chronic pulmonary and cardiovascular diseases were the most frequent comorbidities. In both groups, Pseudomonas aeruginosa was the predominant microorganism, particularly affecting patients with immunosuppression (25.3% vs. 16.7%, p = 0.032). Cox regression model adjusted for disease severity (SAPS II), polytraumatized status, altered consciousness, and postoperative status, SAPS II remained a strong independent predictor of mortality, with each one-point increase associated with a 2.3% higher risk of death (HR: 1.023, 95% CI 1.017-1.030, p < 0.001). The analysis also revealed significant heterogeneity in mortality risk among immunosuppressed patients, with hematological malignancies, recent chemotherapy, and bone marrow transplantation associated with the highest mortality. Conclusions: Immunosuppressed patients had a lower adjusted survival probability compared to non-immunosuppressed patients. Moreover, P. aeruginosa was the most frequently identified etiological pathogen in immunosuppressed patients.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Reyes LF, Sanabria-Herrera N, Nseir S, Ranzani OT, Povoa P, Diaz E, et al. Nosocomial lower respiratory tract infections in patients with immunosuppression: a cohort study. Ann Intensive Care. 2025 May 6;15(1):61. DOI: 10.1186/s13613-025-01462-y
  • dc.identifier.doi http://dx.doi.org/10.1186/s13613-025-01462-y
  • dc.identifier.issn 2110-5820
  • dc.identifier.uri http://hdl.handle.net/10230/70678
  • dc.language.iso eng
  • dc.publisher Springer
  • dc.relation.ispartof Ann Intensive Care. 2025 May 6;15(1):61
  • dc.rights © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by/4.0/
  • dc.subject.keyword Critical care
  • dc.subject.keyword Immunosuppression
  • dc.subject.keyword Nosocomial lower respiratory tract infections
  • dc.title Nosocomial lower respiratory tract infections in patients with immunosuppression: a cohort study
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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