ICU-acquired infection in neutropenic patients

Among neutropenic patients, sepsis is a frequent cause of ICU admission, and its epidemiology is well described, but data on infection acquired during the ICU stay (ICU-AI) are lacking. We aim to describe, using a large nationwide cohort study, the incidence of ICU-AI for neutropenic patients in a large network of French intensive care units (ICUs). This study was conducted using the healthcare-associated infection surveillance cohort “REA-REZO” involving 265 participating ICUs. All patients admitted to a participating ICU from 1st January 2018 to 31th December 2023, for more than 48 h were eligible. The primary endpoint was the rate of ICU-AI. A matched analysis was conducted using non-parsimonious regression model to compare neutropenic and non-neutropenic patients. Matching process resulted in well-balanced 7545 patients’ pairs. ICU-AI incidence rate was 14.9 versus 13.0 AI per 1000 patients days in the neutropenic group vs non-neutropenic group (Incidence Rate Ratio [IRR] = 1.15 [1.05, 1.25] p = 0.002) with higher incidence rate for bloodstream infection (BSI) (p < 0.001) but comparable incidences rates of pneumonia (p = 0.503) and central-line associated BSI (p = 0.100). There were less enterobacterales among ICU-AI of the neutropenic group (33.8% vs 45.4%, p < 0.001), but higher rate of coagulase negative Staphylococcus (12.0% vs 5.2%, p < 0.001), Enterococcus spp, (8.9% vs 6.0%, p = 0.015) and Candida spp. (10.4% vs 6.2%, p = 0.001). Rates of ICU-AI involving multidrug resistant micro-organisms did not differed, neither did the rate of ICU-AI involving non fermenting Gram-negative bacilli. Neutropenic patients had higher ICU-AI incidence as compared with non-neutropenic patients, specifically through an increase of BSI incidence. Microbiology differs between neutropenic patients and non-neutropenic patients with no difference in multidrug resistant microorganism involvement.

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Journal
Critical Care
Published
2026-03-17
DOI
https://doi.org/10.1186/s13054-026-05890-5
Primary Topic
Neutropenia and Cancer Infections
Type
article
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article

ICU-acquired infection in neutropenic patients

Joël Delhomme, Gilles Troché, Michel Pascal, Sébastien Beague et al.
Critical Care
Neutropenia and Cancer Infections
article

ICU-acquired infection in neutropenic patients

Joël Delhomme, Gilles Troché, Michel Pascal, Sébastien Beague, Bertrand Texier, Cédric Dananché, Bassam Beilouny, Robert Chausset, Gaëlle Gasan, Mélanie Chauvet, Anne-Sophie Le Floch, Clarisse Dupin, François Tinturier, Océane Bernard de Lajartre, M. Durand, Daniel Carbognani, Michel Kaidomar, Fanny Le Gall, Béatrice La Combe, Benjamin Louart, Sylvie Joron, Céline Ragot, G. Rolland-Jacob, Christian Crombé, Delphine Grau, Julien Huntzinger, Julien Dupeyrat, Guy Launoy, Frédérique Diaw, C. Neulier, Jean-Christophe Navellou, Karim Merouani, Aurélie Thomas-hervieu, Patrick Inácio Pina, Guillaume Loup, Thomas Lescot, Dominique Jusserand, B. Jolibois, M Vitris, Alexandre Toro, P. Corne, C. Venot, Sylvie Comparot, Nicolas Bèle, F. Gourdon, Olivier Delastre, Antoine Romen, Laurène Nathalie Dupont, M.L. Valdeyron, Hussein N. Yassine, Isabelle Geneau, Thierry Dulac, Thierry Lavigne, A Fribourg, Anne Savey, Aurore Loquet, Fabrice Thiollière, B. Mankikian, T. Geffriaud, Rémi Trusson, Arnaud Friggeri, Richard Galliot, Sébastien Gibot, Vincent Stoeckel, Isabel Roca-Cerezo, Muriel Le Coq, Anne Lignereux, Lyes Knani, Candice Fontaine, Stanislas Ledochowski, Asma Jeblaoui, Nicolas Belin, Vanessa Chartier, Lassane Zanre, Philippe Lehoux, Michel Bonnivard, Sylvain Garnier, F. Delanghe, Christophe Giacardi, Abla Daroukh, Frédérique Pavillard, Alexandre Herbland, C. Simac, Morgan Caplan, Sabrina Habchi, Toufic Finge, Olivier Martinet, Stéphanie Bordes-Couecou, Olga Raposo, Jérôme Pillot, Gaëlle Cosmao, Salman ben Abdel Aziz ben Salman ben Mohammad, Alexandra Allaire, Matthieu Capron, D Trivier, Gaëlle Corno, Mathieu Boutonnet, Pierre Yves Egreteau, Sylvie Bourzeix, François Mallard, Stéphane Rouleau, C. Bourigault, Matthieu Duprey, Catherine Haond, Olivier Pajot, Abdelkrim Abdelmalek, Odile Bajolet, S. Boutreux, Abdelali Ouchikhe, Catherine Chubilleau, Franck Verdonk, Cécile Zylberfajn, C Henry, Geneviève Barjon, Charles‐Hervé Vacheron, T.A.V. Randriamandrato, Peggy Larroude, Marion Gleize, Serge Alfandari, L. Poiron, E. Munier-Marion, Mélanie Levrard, Alexandre Tonnelier, Lionel Ursulet, Patricia Courouble, Audrey Glanard, P. Baune, Virginie Maxime, Carole Eldin, Sébastien Moschietto, Pascale Martres, Audrey Martin, Marie Callanquin, Jean-François Vincent, Santiago Gil, Marie Laure Lier, Damien Dassant, Julie Bertrand, F. Espinasse, Michel Sirodot, Walter Picard, S. Lacroix, O. Passouant, Jacques-Yves Nizou, Hughes Georges, Adrien Robine, C. Perdrix, Marie Reine Mallaret, J. Mariot, Loïc Dopeux, Jean-Yves Dusseau, Éric Farfour, Nacim Ammenouche, Nathalie Canu, Julien Gaubert-Duclos, Eve Remy, Rusel Leon, Sylvie Picault, Vincent Quenee, Cristian Prelipcean, Laurence Vasse, Caroline Aurel, Liliane Grolier-bois, Laurianne Buyer, Magali Bauer Grandpierre, Monzer Dabbachi, Lucie Lecoutre, Blandine Placet, Amine Bouriga, Fethi Hadj-slimane, Abdelhamid Fatah, Julie Brochart, Laetitia Rohr, Cécile Bernerd, Anne-Claude Roche, Jérôme Roustan, Ella-Pauline Meyer, Claude Galland, Véronique Curnier, Christiane Manzon, Martine Daumas, Valérie Gauzere, Karim Hellal, Julie Racaud, Marie Hélène Hausermann, Philippe Tagawa, Severine Bonjean, Laeticia Renard, David Tranvan, Francoise Adema, Fabienne Derramond, Laure Mons, Gaelle Ribeyre, Isabelle Dijols, Dominique Nicollon, Dominique Deffarges, Marieline Goret, Dominique Sechaud, Sandrine Biangoma, Quoc Vien Le, Fabienne Birot Jaulin, Aurélie Maindron, Abdenour Bouhara, Aude Spitz, Marie-Elisabeth Cornesse, Amine Si-ali, Claire Maheu, Béatrice Grisi, Isabelle Durand Joly, Benoit Thiphagne, Jean Paul Délias, Michele Gourgues, Françoise Hayo, Vincent Catanese, Katia Lamant, Sophie Duhoo, Margaux Duboin, Solweig Gerbier Colomban, Philippe Mardrus, Hanene Bouzidi, Aurélien Daurat, Véronique Fleurial, Céline Clayer, Sabine PEGHAIRE, Yannick Fedun, Georges Simon, Florent Wallet, Jean Kempf, Catherine Rougier, Jean-Louis Dubost, Emmanuelle Hammad, Frédéric Barbut, René-Gilles Patrigeon, Claire Bianchi, Brigitte Le Tallec, Faouzi Saliba, Nicolas Massart, Maelle Martin, Clotilde Groleau, Sylvie Ricome, the REA-REZO study group, Florence Lemann, Martine Delorme, Marie Labruyere, Claire Lepouse, Esther Cortes, Bernadette Laurent, Christian Pommier, Emmanuel Vivier, Gauthier Julien, Aziz Berrouba, Céline Muller, Johana Perez, Caroline Cyvoct, Philippe Bouillard, Antonio Álvarez, Vincent Castelain, Géraldine Dessertaine, Gaëtan Plantefeve, Laysa Saadi, Fabrice Chopin, Nicolat Boussekey, Judith Pibre, Hervé Hyvernat, Ferhat Meziani, Paul-Simon Pugliesi, Anaïs Machut, Alain Lepape, Adrien Roques, Mélanie Saint-Leger, Pierre Fillatre, Stéphanie Bulyez, Sabine Reynaud Deforges, Yasmina Berrouane, Rémi Plattier, Arnaud Florentin, Jean-Sebastien Petit, Florian Reizine, Bruno Lafon, Luis Vicente Ferreira, Jean-Christophe Richard, Nicholas Sedillot, Severine Gallais-Hoff, Emmanuelle Martin, Olivier Meunier, Alexandre Jean, Romain Persichini, Thomas Rimmele, Isabelle Cattaneo, François Nicolas, Christine Lawrence, Kamel Djedaini, Gérard Audibert, Christine Palitta, Marine Tasle, Catherine Vallet, Vanessa Van Rosse, Gaël Pradel, Catherine Guignabert, Myriam Venelle, Guillaume Chassaing, Laurent Argaus, Magdalena Szczot, Antoine Vieillard-Baron
article en

Abstract

Among neutropenic patients, sepsis is a frequent cause of ICU admission, and its epidemiology is well described, but data on infection acquired during the ICU stay (ICU-AI) are lacking. We aim to describe, using a large nationwide cohort study, the incidence of ICU-AI for neutropenic patients in a large network of French intensive care units (ICUs). This study was conducted using the healthcare-associated infection surveillance cohort “REA-REZO” involving 265 participating ICUs. All patients admitted to a participating ICU from 1st January 2018 to 31th December 2023, for more than 48 h were eligible. The primary endpoint was the rate of ICU-AI. A matched analysis was conducted using non-parsimonious regression model to compare neutropenic and non-neutropenic patients. Matching process resulted in well-balanced 7545 patients’ pairs. ICU-AI incidence rate was 14.9 versus 13.0 AI per 1000 patients days in the neutropenic group vs non-neutropenic group (Incidence Rate Ratio [IRR] = 1.15 [1.05, 1.25] p = 0.002) with higher incidence rate for bloodstream infection (BSI) (p < 0.001) but comparable incidences rates of pneumonia (p = 0.503) and central-line associated BSI (p = 0.100). There were less enterobacterales among ICU-AI of the neutropenic group (33.8% vs 45.4%, p < 0.001), but higher rate of coagulase negative Staphylococcus (12.0% vs 5.2%, p < 0.001), Enterococcus spp, (8.9% vs 6.0%, p = 0.015) and Candida spp. (10.4% vs 6.2%, p = 0.001). Rates of ICU-AI involving multidrug resistant micro-organisms did not differed, neither did the rate of ICU-AI involving non fermenting Gram-negative bacilli. Neutropenic patients had higher ICU-AI incidence as compared with non-neutropenic patients, specifically through an increase of BSI incidence. Microbiology differs between neutropenic patients and non-neutropenic patients with no difference in multidrug resistant microorganism involvement.

Critical Care
Université Claude Bernard Lyon 1 (FR), Centre National de la Recherche Scientifique (FR), Hospices Civils de Lyon (FR), Centre Hospitalier de Saint-Brieuc (FR), Centre hospitalier Bretagne Atlantique (FR), Hôpital Lyon Sud (FR), Centre Hospitalier Universitaire de Rennes (FR), Centre International de Recherche en Infectiologie (FR), Imation (United States) (US)
Openalex Percentile: Top 19%
Neutropenia and Cancer Infections
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