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Propofol Associated with Increased Infections in Critically Ill Patients: Presented at ASA

By Deborah Brauser

ORLANDO, Fla -- October 21, 2008 -- A continuous infusion of propofol can lead to increased infections in intensive care unit (ICU) patients, according to research presented here at the American Society of Anesthesiologists (ASA) 2008 Annual Meeting.

Lead investigator Samir Haddad, MD, University of Alabama at Birmingham, Birmingham, Alabama, and Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia, reported the results on October 19.

Though Dr. Haddad submitted this study while working at the University of Alabama, it was conducted in the medical surgical ICU in the Riyadh hospital.

Dr. Haddad and colleagues studied 523 consecutive patients who were admitted to the ICU and received sedation for 48 hours or more. A total of 124 patients a mean age of 38 years were given propofol, while 399 patients a mean age of 57 years were treated without propofol.

Dr. Haddad's team then collected data on patients' demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, admission categories, chronic illnesses, and sedative use. The team also documented ICU-acquired infections in the following categories: all infections, ventilator-associated pneumonia, urosepsis, tracheobronchitis, and catheter-related infections/blood stream infections, as well as incidences of sepsis (clinical sepsis, severe sepsis, and septic shock), and ICU and hospital mortality.

Results show that the rate of ICU-acquired infection was higher in the propofol group than in the control group (50% vs 35.3%, respectively; P = .003), but hospital mortality was significantly lower in the propofol group (17.7% vs 33.3%; P = .0009).

On multivariate analysis, the researchers found that risk of infection was higher in the propofol-treated group compared with the control group (odds ratio [OR] = 2.08; confidence interval [CI], 1.29-3.34; P = .003). However, they found no significant difference in ICU mortality (OR = 0.94; CI, 0.47-1.85; P = .85) or hospital mortality (OR = 0.74; CI, 0.41-1.31; P = .3).

Said Dr. Haddad, "We were not sure whether using propofol in the ICU was associated with increased infection. This was well known in the use of propofol in the operating room as intravenous anaesthesia. But in the ICU, this has not been shown before."

He continued, "I can not conclude that propofol should not be used because it increases infection. But we should make sure we know why it increases infection. Most people believe it is because it's a lipid-based drug, and lipid is well known to increase bacterial growth. That could be the major mechanism."

He said his team plans to conduct more studies to look at this result.

[Presentation title: Relation Between Propofol Infusion and Outcomes of Critically Ill Patients. Abstract A-417]

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