Antibiotic Prescriptions in Critically Ill Patients with Bloodstream Infection Due to ESBL-Producing Enterobacteriaceae: Compliance with the French Guidelines for the Treatment of Infections with Third-Generation Cephalosporin-Resistant Enterobacteriaceae—A Multicentric Retrospective Cohort Study
Abstract
:1. Introduction
2. Patients and Methods
2.1. Setting and Study Population
2.2. Data Collection
2.3. Objectives and Definitions
- In the absence of septic shock and a history of ESBL-E resistant to PIP-TAZ urinary infection/colonization <3 months;
- In the presence of septic shock and a history of ESBL-E urinary infection/colonization or antibiotic treatment within 3 months.
- A history of ESBL-E urinary infection/colonization or antibiotic treatment within 3 months.
- Treatment with PIP-TAZ or a cephalosporin active against P. aeruginosa within 1 month;
- A history of ESBL-E or PIP-TAZ resistant P. aeruginosa infection/colonization within 3 months.
- In the case of ESBL-E colonization:
- In the case of septic shock and a history of ESBL-E colonization/infection within 3 months.
- Acute pyelonephritis or complicated UTI with a susceptible strain in order of preference: trimethoprim–sulfamethoxazole, fluoroquinolone, cefoxitin (in case of E. coli), temocillin, amoxicillin–clavulanate, PIP-TAZ, and aminoglycosides;
- Intra-abdominal infection with a controlled source of infection and a strain with PIP-TAZ CMI ≤ 4: PIP-TAZ;
- Pneumonia and a strain with PIP-TAZ CMI ≤ 4: PIP-TAZ; otherwise, if susceptibility to quinolone: a fluoroquinolone. The use of temocillin or trimethoprim–sulfamethoxazole could be proposed.
2.4. Statistical Analysis
3. Results
3.1. Demographic and Clinical Data
3.2. Microbiological Data
3.3. Empirical Antibiotic Treatment
3.4. Adequation and Appropriateness of Empirical Antibiotic Treatment
3.5. Factors Associated with an Empirical Prescription of a Carbapenem in Adequation with the Guidelines
3.6. Definitive Antibiotic Treatment and Adequation with the Guidelines
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Variable | Total (n = 185) |
---|---|
Demographics | |
Age (years), median (IQR) | 60 (19) |
Male, n (%) | 126 (68.0) |
Underlying diseases, n (%) | |
McCabe > 1 | 53 (28.6) |
Diabetes mellitus | 64 (34.6) |
Heart failure | 25 (13.5) |
COPD | 34 (18.4) |
Chronic renal insufficiency | 21 (11.4) |
Immunodeficiency, n (%) | 45 (24.3) |
Immunosuppressive therapy | 22 (11.9) |
Solid cancer | 22 (11.9) |
Hematological malignancy | 18 (9.7) |
Transplantation | 9 (4.9) |
Admission, n (%) | |
Medical | 162 (87.6) |
Unscheduled surgical | 23 (12.4) |
ESBL-E risk factors, n (%) | |
Antibiotic treatment in the last 3 months | 153 (82.7) |
Colonization with ESBL-E | 147 (79.5) |
Hospital acquired infection | 166 (89.7) |
Hospital stay before BSI onset, days, median (IQR) | 21 (24) |
ICU stay before BSI onset, days, median (IQR) | 15 (22) |
Source of BSI, n (%) | |
Pneumonia | 103 (55.7) |
Urinary tract | 26 (14.1) |
Catheter related | 24 (13.0) |
Intra-abdominal | 24 (13.0) |
Unknown | 6 (3.2) |
Disease severity at BSI onset, n (%) | |
SOFA score, median (IQR) | 6 (5) |
Pitt score, median (IQR) | 4 (4) |
Shock | 97 (52.4) |
Mechanical ventilation | 134 (72.4) |
Clinical outcome, n (%) | |
ICU stay, days, median (IQR) | 35 (47) |
In-ICU mortality | 71 (38.4) |
Antibiotics | Total n = 185 | Klebsiella sp. n = 126 | Escherichia coli n = 29 | Enterobacter sp. n = 22 | Others n = 8 |
---|---|---|---|---|---|
Amoxicillin–clavulanate | 19/185 (10) | 9/126 (7) | 10/29 (34) | 0/22 (0) | 1/8 (13) |
Piperacillin–tazobactam | 54/185 (29) | 24/126 (19) | 24/29 (83) | 4/22 (18) | 2/8 (25) |
CMI < 8 | 25/185 (14) | 7/126 (6) | 17/29 (59) | 0/22 (0) | 1/8 (13) |
Temocillin | 47/83 (57) | 26/53 (49) | 12/19 (63) | 9/10 (90) | 0/1 (0) |
Cefoxitin | 83/159 (52) | 69/115 (60) | 14/17 (82) | 0/20 (0) | 0/7 (0) |
Cefepime | 59/185 (32) | 43/126 (34) | 4/29 (14) | 9/22 (41) | 3/8 (38) |
Ertapenem | 153/185 (83) | 99/126 (76) | 29/29 (100) | 22/22 (100) | 3/8 (38) |
Ceftazidime–avibactam | 114/120 (95) | 88/93 (95) | 7/8 (88) | 14/14 (100) | 5/5 (100) |
Ceftolozan–tazobactam | 64/109 (59) | 47/83 (57) | 6/6 (100) | 7/15 (47) | 4/5 (80) |
Levofloxacin | 54/185 (29) | 32/126 (25) | 11/29 (38) | 8/22 (36) | 3/8 (38) |
Amikacin | 159/185 (86) | 111/126 (88) | 28/29 (97) | 18/22 (82) | 2/8 (25) |
Colistin | 81/95 (85) | 61/74 (82) | 3/3 (100) | 10/11(91) | 7/7 (100) |
Trimethoprim–sulfamethoxazole | 40/185 (22) | 23/126 (18) | 13/29 (45) | 1/22 (5) | 3/8 (38) |
Tigecyclin | 81/95 (85) | 61/74 (82) | 3/3 (100) | 10/11 (91) | 7/7 (100) |
Variables | Factors Associated with an Adequate Empirical Prescription of a Carbapenem | |||
---|---|---|---|---|
Univariate | Multivariate | |||
OR (CI 95%) | p | OR (CI 95%) | p | |
Sex (Male) | 0.744 [0.256–2.162] | 0.587 | ||
Age | 0.975 [0.938–1.012] | 0.186 | 0.979 [0.918–1.043] | 0.506 |
Diabetes | 1.647 [0.539–5.030] | 0.381 | ||
Chronic cardiac insufficiency | 1.776 [0.368–8.575] | 0.475 | ||
Chronic respiratory insufficiency | 0.328 [0.109–0.990] | 0.048 | 0.551 [0.115–2.631] | 0.455 |
Chronic renal insufficiency | 2.250 [0.267–18.929] | 0.456 | ||
Cancer | 0.584 [0.139–2.450] | 0.463 | ||
Hemopathy | 2.250 [0.267–18.929] | 0.456 | ||
Immunodepression | 1.989 [0.528–7.496] | 0.310 | ||
Antibiotic allergy | 0.935 [0.098–8.879] | 0.953 | ||
Antibiotics within 3 months | 1.083 [0.316–3.711] | 0.899 | ||
ESBL colonization | 54.312 [10.192–289.417] | <0.0001 | 107.921 [9.303–1251.910] | 0.0002 |
Length of stay in hospital | 1.009 [0.987–1.031] | 0.422 | ||
SOFA at BSI onset | 54.312 [10.192–289.417] | 0.008 | 1.061 [0.787–1.431] | 0.696 |
Septic shock | 3.885 [1.334–11.313] | 0.013 | 11.029 [0.936–129.888] | 0.056 |
VM at BSI onset | 0.874 [0.300–2.548] | 0.805 | ||
Respiratory source of BSI | 3.152 [1.087–9.134] | 0.035 | 3.456 [0.768–15.558] | 0.106 |
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Le Berre, C.; Houard, M.; Vachée, A.; Georges, H.; Wallet, F.; Patoz, P.; Herbecq, P.; Nseir, S.; Delannoy, P.-Y.; Meybeck, A. Antibiotic Prescriptions in Critically Ill Patients with Bloodstream Infection Due to ESBL-Producing Enterobacteriaceae: Compliance with the French Guidelines for the Treatment of Infections with Third-Generation Cephalosporin-Resistant Enterobacteriaceae—A Multicentric Retrospective Cohort Study. Microorganisms 2023, 11, 2676. https://doi.org/10.3390/microorganisms11112676
Le Berre C, Houard M, Vachée A, Georges H, Wallet F, Patoz P, Herbecq P, Nseir S, Delannoy P-Y, Meybeck A. Antibiotic Prescriptions in Critically Ill Patients with Bloodstream Infection Due to ESBL-Producing Enterobacteriaceae: Compliance with the French Guidelines for the Treatment of Infections with Third-Generation Cephalosporin-Resistant Enterobacteriaceae—A Multicentric Retrospective Cohort Study. Microorganisms. 2023; 11(11):2676. https://doi.org/10.3390/microorganisms11112676
Chicago/Turabian StyleLe Berre, Camille, Marion Houard, Anne Vachée, Hugues Georges, Frederic Wallet, Pierre Patoz, Patrick Herbecq, Saad Nseir, Pierre-Yves Delannoy, and Agnès Meybeck. 2023. "Antibiotic Prescriptions in Critically Ill Patients with Bloodstream Infection Due to ESBL-Producing Enterobacteriaceae: Compliance with the French Guidelines for the Treatment of Infections with Third-Generation Cephalosporin-Resistant Enterobacteriaceae—A Multicentric Retrospective Cohort Study" Microorganisms 11, no. 11: 2676. https://doi.org/10.3390/microorganisms11112676