Relationship of multidrug-resistant bacterial colonization and immune status of patients in the ICU

Excerpt

An observational cohort study recently conducted by Kreitmann et al. [1] reported that immunocompromised patients in the intensive care unit (ICU) had a lower incidence rate of multidrug-resistant (MDR) bacterial colonization and infection. The authors adopted a prospective design; however, the immune status of the participants was recorded on the last day (Day 28) of the follow-up period. Therefore, this study may have incorrectly allocated ICU patients, such as those with acute respiratory distress syndrome and near-fatal asthma, who required high-dose steroids due to acute conditions instead of chronic diseases by not accounting for the long-term (≥ 28 days) use of steroids or other immunosuppressants. Furthermore, nasal and rectal swab sampling upon admission and every week until ICU discharge resulted in different sampling numbers for each patient. The incidence rate of MDR bacterial colonization was then biased by different sensitivity of pathogen detection (higher yield from more sampling times for a longer ICU stay) in each patient. …