Bloodstream infections among patients receiving therapeutic plasma exchanges in the intensive care unit: a 10 year multicentric study

Sofiane Fodil; Tomas Urbina; Swann Bredin; Julien Mayaux; Antoine Lafarge; Louaï Missri; Eric Maury; Alexandre Demoule; Frederic Pene; Eric Mariotte; Hafid Ait-Oufella

doi:10.1186/s13613-024-01346-7

Bloodstream infections among patients receiving therapeutic plasma exchanges in the intensive care unit: a 10 year multicentric study

Ann Intensive Care. 2024 Jul 29;14(1):117. doi: 10.1186/s13613-024-01346-7.

Authors

Affiliations

¹ Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.
² Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.
³ Service de Médecine Intensive-Réanimation, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁴ Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁵ Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. hafid.aitoufella@aphp.fr.
⁶ Inserm U970, Cardiovascular Research Center, Université Paris-Cité, Paris, France. hafid.aitoufella@aphp.fr.

^# Contributed equally.

Abstract

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.

Keywords: Bloodstream infections; Critical care; Health-care acquired infections; Intensive care unit; Intra-vascular catheter infection; Therapeutic plasma exchange.