title: Severe hypothermia increases the risk for intensive care unit-acquired infection.
abstract: BACKGROUND
  Although hypothermia is widely accepted as a risk factor for subsequent infection in surgical patients, it has not been well defined in medical patients. We sought to assess the risk of acquiring intensive care unit (ICU)--acquired infection after hypothermia among medical ICU patients.
  
  
  METHODS
  Adults (≥18 years) admitted to French ICUs for at least 2 days between April 2000 and November 2010 were included. Surgical patients were excluded. Patient were classified as having had mild hypothermia (35.0°C-35.9°C), moderate hypothermia (32°C-34.9°C), or severe hypothermia (<32°C), and were followed for the development of pneumonia or bloodstream infection until ICU discharge.
  
  
  RESULTS
  A total of 6237 patients were included. Within the first day of admission, 648 (10%) patients had mild hypothermia, 288 (5%) patients had moderate hypothermia, and 45 (1%) patients had severe hypothermia. Among the 5256 patients who did not have any hypothermia at day 1, subsequent hypothermia developed in 868 (17%), of which 673 (13%), 176 (3%), and 19 (<1%) patients had lowest temperatures of 35.0°C-35.9°C, 32.0°C-34.9°C, and <32°C, respectively. During the course of ICU admission, 320 (5%) patients developed ICU-acquired bloodstream infection and 724 (12%) patients developed ICU-acquired pneumonia. After controlling for confounding variables in multivariable analyses, severe hypothermia was found to increase the risk for subsequent ICU-acquired infection, particularly in patients who did not present with severe sepsis or septic shock.
  
  
  CONCLUSIONS
  The presence of severe hypothermia is a risk factor for development of ICU-acquired infection in medical patients.
authors.affiliation: Team 11: Outcome of Respiratory Cancers and Mechanically Ventilated Patients, Integrated Research Center U823-Albert Bonniot Institute, Rond Point de la Chantourne, La Tronche, France.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Laupland
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Clémence
authors.initials: C
authors.lastname: Minet
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vésin
authors.forename: Dany
authors.initials: D
authors.lastname: Goldgran-Toledano
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Yves
authors.initials: Y
authors.lastname: Cohen
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.forename: Samir
authors.initials: S
authors.lastname: Jamali
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.forename: Anne-Sylvie
authors.initials: AS
authors.lastname: Dumenil
authors.forename: Hatem
authors.initials: H
authors.lastname: Kallel
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005602:France; D006801:Humans; D007035:Hypothermia / Q000150:complications*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D018570:Risk Assessment; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult