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The aim of this planned analysis of the prospective multinational TAVeM database was to determine the incidence, aetiology and impact on outcome of ventilator-associated lower respiratory tract infections (VA-LRTI) in immunocompromised patients.  All patients receiving mechanical ventilation for &gt;48 h were included. Immunocompromised patients (n=663) were compared with non-immunocompromised patients (n=2297).  The incidence of VA-LRTI was significantly lower among immunocompromised than among non-immunocompromised patients (16.6%  versus  24.2%; sub-hazard ratio 0.65, 95% CI 0.53–0.80; p&lt;0.0001). Similar results were found regarding ventilator-associated tracheobronchitis (7.3%  versus  11.6%; sub-hazard ratio 0.61, 95% CI 0.45–0.84; p=0.002) and ventilator-associated pneumonia (9.3%  versus  12.7%; sub-hazard ratio 0.72, 95% CI 0.54–0.95; p=0.019). Among patients with VA-LRTI, the rates of multidrug-resistant bacteria (72%  versus  59%; p=0.011) and intensive care unit mortality were significantly higher among immunocompromised than among non-immunocompromised patients (54%  versus  30%; OR 2.68, 95% CI 1.78–4.02; p&lt;0.0001). In patients with ventilator-associated pneumonia, mortality rates were higher among immunocompromised than among non-immunocompromised patients (64%  versus  34%; p&lt;0.001).  Incidence of VA-LRTI was significantly lower among immunocompromised patients, but it was associated with a significantly higher mortality rate. Multidrug-resistant pathogens were more frequently found in immunocompromised patients with VA-LRTI.

Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections