重症监护病房接受治疗性血浆置换患者的血流感染:一项为期 10 年的多中心研究。

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE Annals of Intensive Care Pub Date : 2024-07-29 DOI:10.1186/s13613-024-01346-7
Sofiane Fodil, Tomas Urbina, Swann Bredin, Julien Mayaux, Antoine Lafarge, Louaï Missri, Eric Maury, Alexandre Demoule, Frederic Pene, Eric Mariotte, Hafid Ait-Oufella
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引用次数: 0

摘要

背景:治疗性血浆置换(TPE)会影响体液反应,通常与免疫抑制剂联合使用。因此,TPE 可能与感染易感性增加有关。我们旨在描述接受 TPE 治疗的 ICU 患者的血流感染(BSI)发生率,并找出相关的风险因素:我们回顾性地纳入了 2010 年 1 月 1 日至 2019 年 12 月 31 日期间在 4 个参与中心(均位于法国巴黎)的重症监护病房接受过至少一次 TPE 治疗的患者。在重症监护室住院期间出现 BSI 的患者与未出现此类感染的患者进行了比较。通过多变量逻辑回归模型确定了BSI的风险因素:在4个重症监护室的10年中,共纳入了387名患者,每名患者的TPE疗程中位数为5[2-7]次。TPE最常见的适应症是血栓性微血管病(47%)、中枢神经系统炎症性疾病(11%)、高粘滞性综合征(11%)和ANCA相关性血管炎(8.5%)。31名患者(8%)在重症监护病房住院期间出现了BSI,中位数为TPE开始后7[3-11]天。在多变量逻辑回归模型中,糖尿病(OR 3.32 [1.21-8.32])和 TPE 治疗总次数(OR 1.14 [1.08-1.20])是 BSI 的独立风险因素。在导管插入部位(P = 0.458)或与 TPE 导管相关的深静脉血栓形成率(P = 0.601)方面,与 TPE 导管感染相关的 BSI(n = 11 (35%))和其他来源的 BSI(n = 20 (65%))之间没有差异。与未发生血流感染的患者相比,发生血流感染的患者重症监护室病程较长,需要更多的机械通气(45% 对 18%,p = 0.001)、肾脏替代疗法(42% 对 20%,p = 0.011)、血管加压药(32% 对 12%,p = 0.004)和更高的死亡率(19% 对 5%,p = 0.010):结论:在重症监护室接受 TPE 治疗的患者经常会发生血流感染,并与重症监护室的严重病程有关。对接受大量 TPE 治疗的患者进行严密监测至关重要。
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Bloodstream infections among patients receiving therapeutic plasma exchanges in the intensive care unit: a 10 year multicentric study.

Background: Therapeutic plasma exchanges (TPE), which affect the humoral response, are often performed in combination with immunosuppressive drugs. For this reason, TPE may be associated with an increased susceptibility to infections. We aimed to describe blood stream infection (BSI) incidence in ICU patients treated with TPE and to identify associated risk factors.

Methods: We retrospectively included patients that had received at least one session of TPE in the ICU of one of the 4 participating centers (all in Paris, France) between January 1st 2010 and December 31th 2019. Patients presenting with a BSI during ICU stay were compared to patients without such an infection. Risk factors for BSI were identified by a multivariate logistic regression model.

Results: Over 10 years in the 4 ICUs, 387 patients were included, with a median of 5 [2-7] TPE sessions per patient. Most frequent indications for TPE were thrombotic microangiopathy (47%), central nervous system inflammatory disorders (11%), hyperviscosity syndrome (11%) and ANCA associated vasculitis (8.5%). Thirty-one patients (8%) presented with a BSI during their ICU stay, a median of 7 [3-11] days after start of TPE. In a multivariate logistic regression model, diabetes (OR 3.32 [1.21-8.32]) and total number of TPE sessions (OR 1.14 [1.08-1.20]) were independent risk factors for BSI. There was no difference between TPE catheter infection related BSI (n = 11 (35%)) and other sources of BSI (n = 20 (65%)) regarding catheter insertion site (p = 0.458) or rate of TPE catheter related deep vein thrombosis (p = 0.601). ICU course was severe in patients presenting with BSI when compared to patients without BSI, with higher need for mechanical ventilation (45% vs 18%, p = 0.001), renal replacement therapy (42% vs 20%, p = 0.011), vasopressors (32% vs 12%, p = 0.004) and a higher mortality (19% vs 5%, p = 0.010).

Conclusion: Blood stream infections are frequent in patients receiving TPE in the ICU, and are associated with a severe ICU course. Vigilant monitoring is crucial particularly for patients receiving a high number of TPE sessions.

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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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