(537) Nosocomial Infections in COVID-19 ICU Cancer Patients: No Impact on ICU Mortality?

Introduction: Nosocomial infections occur in 14-37% of Intensive Care Unit (ICU) COVID-19 patients and increase morbidity and mortality. Its impact could be significant in cancer patients with COVID-19 due to their immunosuppressed state. We aimed to describe the incidence and impact of nosocomial infections in ICU cancer patients with COVID-19 pneumonia.

Methods: This was a retrospective cohort study in an oncological ICU, from March 2020-October 2021. Data collected included demographics, type of malignancy, and treatments received in the ICU. Nosocomial infections were defined as positive cultures in the ICU 72 hours after ICU admission. Data were summarized using median and interquartile range for continuous variables, frequency counts and percentages for categorical variables. To evaluate difference of categorical and continuous variables between groups we used the Chi-square and Wilcoxon rank sum test/Kruskal-Wallis tests.

Results: There were 94 cancer patients admitted to the ICU with COVID-19 pneumonia in the 20-month study period. The most common malignancies were hematological (56%); among them, leukemias (26.6%) and lymphomas (16.6%). Median SOFA scores were 4 (2-6), 57.4% of the patients required vasopressors, 56.4% mechanical ventilation, and the overall mortality was 58.5%. All patients received antibiotics during their ICU stay and superimposed nosocomial infections were documented in 33% of patients during the ICU stay (60% bacterial, 30% fungal, and 10% viral). Type of malignancy, cancer treatment within 3 months prior to their ICU admission, and presence of lymphopenia and neutropenia were similar between patients with and without nosocomial infections. The use of tocilizumab, anakinra, corticosteroids and convalescent plasma showed no statistically significant differences between groups. Mortality was higher in patients with nosocomial infections (71%) compared to those without infections (52.4%), but it did not reach statistical significance (p value: 0.08).

Conclusions: Cancer patients had a similar incidence of nosocomial infections than reported in non-cancer ICU patients with COVID-19. Nosocomial infections in this population did not seem to significantly increase mortality; however, factors such as sample size could have affected the results. Larger cohorts are necessary.