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- Title
In-ICU-acquired infections in flare-up systemic rheumatic disease patients receiving immunosuppressant.
- Authors
Assan, Florence; Bay, Pierre; Mathian, Alexis; Hekimian, Guillaume; Bréchot, Nicolas; Quentric, Paul; Moyon, Quentin; Schmidt, Matthieu; Cohen-Aubart, Fleur; Haroche, Julien; Amoura, Zahir; Luyt, Charles-Edouard; Combes, Alain; Pineton de Chambrun, Marc
- Abstract
Objectives: Systemic rheumatic diseases (SRDs) are a group of inflammatory disorders that can need intensive care unit (ICU) admission during a flare-up, requiring administration of immunosuppressants. We undertook this study to determine the frequency, outcome, and occurrence associated factors of infections in flare-up SRD patients receiving immunosuppressant. Methods: Monocenter, a retrospective study including SRD patients admitted to ICU for a flare-up requiring immunosuppressant from 2004 to 2019. The primary endpoint was in-ICU-acquired infections. Results: Ninety-eight patients (female/male ratio: 1.6; mean age at admission: 39.5 ± 17.4 years) were admitted to the ICU for a SRD flare-up, inaugural in 61.2% cases. A specific treatment was given to every patient: corticosteroids 100%, cyclophosphamide 45.9%, plasma exchange 46.9%. Ninety-five infections occurred in 35 (36%) patients mainly pneumonias. The overall in-hospital mortality was 17.3%, and 46% of patients with a nosocomial infection died during their ICU stay. The logistic regression multivariable model retained renal replacement therapy and mechanical ventilation as independent predictors of infection. Conclusion: In-ICU-acquired infection in SRD flare-up is a frequent event associated with organ failures but not with in-ICU use of immunosuppressants. These data suggest that the fear of infection should not withhold a careful in-ICU use of immunosuppressive drugs. Key Points • In-ICU infections are frequent in flare-up systemic rheumatic disease patients. • Infections are associated with increased mortality. • Cyclophosphamide given in ICU was not independently associated with infection. • Severe neutropenia occurred in 27% of patients receiving cyclophosphamide in ICU.
- Subjects
RHEUMATISM; ARTIFICIAL respiration; INTENSIVE care units; RENAL replacement therapy; NOSOCOMIAL infections
- Publication
Clinical Rheumatology, 2022, Vol 41, Issue 9, p2845
- ISSN
0770-3198
- Publication type
Article
- DOI
10.1007/s10067-022-06197-w