Migrants in the intensive care unit: time to show we care

Hraiech, Sami; Papazian, Laurent; Azoulay, Élie

doi:10.1007/s00134-020-06318-6

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…In intensive care units (ICUs), HAP refers to both healthcare-associated pneumonia and ventilator-associated pneumonia 3 . The attributable mortality of ventilator-associated pneumonia has been extensively evaluated in recent studies 4 – 6 , although this has led to conflicting results because of confounding biases 7 . Likewise, the attributable mortality of ICU-acquired pneumonia—that is, healthcare-associated pneumonia diagnosed after a 48 h stay in the ICU—remains difficult to accurately assess.…”

Section: Introductionmentioning

confidence: 99%

Association between mortality and highly antimicrobial-resistant bacteria in intensive care unit-acquired pneumonia

Lakbar

Medam²,

Ronflé³

et al. 2021

Sci Rep

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Data on the relationship between antimicrobial resistance and mortality remain scarce, and this relationship needs to be investigated in intensive care units (ICUs). The aim of this study was to compare the ICU mortality rates between patients with ICU-acquired pneumonia due to highly antimicrobial-resistant (HAMR) bacteria and those with ICU-acquired pneumonia due to non-HAMR bacteria. We conducted a multicenter, retrospective cohort study using the French National Surveillance Network for Healthcare Associated Infection in ICUs (“REA-Raisin”) database, gathering data from 200 ICUs from January 2007 to December 2016. We assessed all adult patients who were hospitalized for at least 48 h and presented with ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii. The association between pneumonia caused by HAMR bacteria and ICU mortality was analyzed using the whole sample and using a 1:2 matched sample. Among the 18,497 patients with at least one documented case of ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii, 3081 (16.4%) had HAMR bacteria. The HAMR group was associated with increased ICU mortality (40.3% vs. 30%, odds ratio (OR) 95%, CI 1.57 [1.45–1.70], P < 0.001). This association was confirmed in the matched sample (3006 HAMR and 5640 non-HAMR, OR 95%, CI 1.39 [1.27–1.52], P < 0.001) and after adjusting for confounding factors (OR ranged from 1.34 to 1.39, all P < 0.001). Our findings suggest that ICU-acquired pneumonia due to HAMR bacteria is associated with an increased ICU mortality rate, ICU length of stay, and mechanical ventilation duration.

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Section: Introductionmentioning

confidence: 99%

Association between mortality and highly antimicrobial-resistant bacteria in intensive care unit-acquired pneumonia

Lakbar

Medam²,

Ronflé³

et al. 2021

Sci Rep

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“…The part of undocumented migrants (UM) admitted to French intensive care units (ICUs) has been constantly increasing during the last decade [ 1 ] despite the so-called “healthy migrants hypothesis” [ 2 ]. Harshness of the travel and living conditions as well as barriers to primary healthcare access at least partly explain the frailty of undocumented people, asylum seekers and refugees towards critical illness [ 3 ]. Before the Coronavirus Disease 2019 (COVID-19) pandemic, in France, undocumented migrants had a higher risk than general population for being admitted to the ICU because of acute respiratory failure or severe infection [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 among undocumented migrants admitted to French intensive care units during the 2020–2021 period: a retrospective nationwide study

Hraiech,

Pauly,

Orleans

et al. 2023

Ann. Intensive Care

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Background Before the Coronavirus Disease 2019 (COVID-19) pandemic in France, undocumented migrants had a higher risk than general population for being admitted to the intensive care unit (ICU) because of acute respiratory failure or severe infection. Specific data concerning the impact of COVID-19 on undocumented migrants in France are lacking. We aimed to analyze the mortality and respiratory severity of COVID-19 in this specific population. We retrospectively included all undocumented adult migrants admitted in French ICUs from March 2020 through April 2021 using the French nationwide hospital information system (Programme de Médicalisation des Systèmes d’Information). We focused on admissions related to COVID-19. Undocumented migrants were compared to the general population, first in crude analysis, then after matching on age, severity and main comorbidities. The primary outcome was the ICU mortality from COVID-19. Secondary objectives were the incidence of acute respiratory distress syndrome (ARDS), the need for mechanical ventilation (MV), the duration of MV, ICU and hospital stay. Results During the study period, the rate of ICU admission among patients hospitalized for COVID-19 was higher for undocumented migrants than for general population (463/1627 (28.5%) vs. 81 813/344 001 (23.8%); p < 0.001). Although ICU mortality was comparable after matching (14.3% for general population vs. 13.3% for undocumented migrants; p = 0.50), the incidence of ARDS was higher among undocumented migrants (odds ratio, confidence interval (OR (CI)) 1.25 (1.06–1.48); p = 0.01). Undocumented migrants needed more frequently invasive MV (OR (CI) 1.2 (1.01–1.42); p = 0.04 than general population. There were no differences between groups concerning duration of MV, ICU and hospital length of stay. Conclusion During the first waves of COVID-19 in France, undocumented migrants had a mortality similar to the general population but a higher risk for ICU admission and for developing an ARDS. These results highlight the need for reinforcing prevention and improving primary healthcare access for people in irregular situation.

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“…We have read with great interest the recent article by Hraiech et al [ 1 ] published in Intensive Care Medicine where the authors manifest their concern about the critical care illness in recently arrived migrants, the unknown incidence, the therapeutic challenges, and the outcomes of this distinctive patients. They mentioned the “migrant crisis” is probably among the most difficult challenges faced by Western countries since the beginning of the twenty-first century.…”

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confidence: 99%