Infections Acquired in the ICU Among Cancer and Other Immunosuppressed Patients: A Nationwide Cohort Study.

Objectives

To compare the cumulative incidence of ICU-acquired infections (ICU-AIs) across distinct immunosuppression diagnostic categories (solid cancer, hematological cancer, other immunosuppression) and nonimmunosuppressed patients, accounting for competing risks of death and discharge.

Design

Retrospective cohort study using prospectively collected data.

Setting

A total of 50 participating ICUs in Brazil. PATIENTS A total of 38,126 adult patients admitted between October 2019 and December 2021 with an ICU stay exceeding 48 hours and no infections diagnosed within the first 48 hours.

Interventions

None.

Measurements

AND MAIN

Results

The primary outcome was the incidence of the first ICU-AI during the ICU stay, evaluated using Fine-Gray subdistribution hazard ratios (sHR). In the multivariable competing-risk analysis, patients with hematological malignancies (sHR, 1.64; 95% CI, 1.01-2.65) and other immunosuppressive conditions (sHR, 1.61; 95% CI, 1.02-2.54) were associated with an increased cumulative incidence of ICU-AI, while solid malignancy was not significantly different from non-immunosuppressed patients (sHR, 0.88; 95% CI, 0.68-1.14).

Conclusions

Patients with hematological malignancies and other immunosuppressive conditions face a significantly higher risk of ICU-AIs.