免疫抑制对于与多重耐药细菌相关的重症监护病房 (ICU) 获得性感染和定植 (分别为 ICU-MDR-col 和 ICU-MDR-inf) 的影响尚不明确。我们在法国的8个 ICU 中进行了观察性前瞻性队列研究（所有 ICU 均为单床病房，具有类似的组织特征）。纳入所有连续住 ICU 超过48小时的患者，不考虑其免疫状态，并进行为期28天的随访。患者入院时及以后每周接受多重耐药细菌的定植筛查。免疫抑制被定义为活动性癌症或血液恶性肿瘤、中性粒细胞减少症、实体器官移植、使用类固醇或免疫抑制药物、艾滋病毒感染和遗传性免疫缺陷等。主要终点是 ICU-MDR-col 和/或 ICU-MDR-inf 的综合发生率。共纳入750名患者（65.9％为男性，中位年龄为65岁），其中264名（35.2％）免疫抑制。ICU 入院原因、疾病严重程度评分以及 ICU 期间接受侵入性设备和抗生素的情况在两组之间相似。根据中心和预先指定的基线混杂因素进行调整后，免疫抑制患者的 ICU-MDR-col 和/或 ICU-MDR-inf 的发生率较低（调整后发生率比为0.68，95％置信区间为0.52-0.91）。单独考虑时，对于 ICU-MDR-col 而言，差异是显著的，但对于 ICU-MDR-inf 而言，则没有显著差异。两组 MDR 细菌的分布相似，以肠杆菌科对第三代头孢菌素的耐药(~74%)为主。免疫抑制患者 ICU-MDR-col 和/或 ICU-MDR-inf 的综合发生率显著较低。该发现指出了接触预防和隔离措施在这一人群中的作用，并可能对该人群的抗生素管理产生重要影响。 © 2022年Springer-Verlag GmbH德国，Springer Nature的一部分。

The impact of immunosuppression on intensive care unit (ICU)-acquired colonization and infection related to multidrug-resistant (MDR) bacteria (ICU-MDR-col and ICU-MDR-inf, respectively) is unknown.We carried out an observational prospective cohort study in 8 ICUs in France (all with single-bed rooms and similar organizational characteristics). All consecutive patients with an ICU stay > 48 h were included, regardless of immune status, and followed for 28 days. Patients underwent systematic screening for colonization with MDR bacteria upon admission and every week subsequently. Immunosuppression was defined as active cancer or hematologic malignancy, neutropenia, solid-organ transplant, use of steroids or immunosuppressive drugs, human immunodeficiency virus infection and genetic. The primary endpoint was the incidence rate of a composite outcome including ICU-MDR-col and/or ICU-MDR-inf.750 patients (65.9% males, median age 65 years) were included, among whom 264 (35.2%) were immunocompromised. Reasons for ICU admission, severity scores and exposure to invasive devices and antibiotics during ICU stay were comparable between groups. After adjustment for center and pre-specified baseline confounders, immunocompromised patients had a lower incidence rate of ICU-MDR-col and/or ICU-MDR-inf (adjusted incidence ratio 0.68, 95% CI 0.52-0.91). When considered separately, the difference was significant for ICU-MDR-col, but not for ICU-MDR-inf. The distribution of MDR bacteria was comparable between groups, with a majority of Enterobacteriacae resistant to third-generation cephalosporins (~ 74%).Immunocompromised patients had a significantly lower incidence rate of a composite outcome including ICU-MDR-col and/or ICU-MDR-inf. This finding points to the role of contact precautions and isolation measures, and could have important implications on antibiotic stewardship in this population.© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.