Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) infections: are carbapenem alternatives achievable in daily practice?
Int J Infect Dis. 2015 Sep 12;39:62-67.
Pilmis B1, Delory T2, Groh M3, Weiss E4, Emirian A5, Lecuyer H6, Lesprit P2, Zahar JR7.
1Université Paris Descartes, Hôpital Necker Enfants Malades, Service de Maladies Infectieuses et Tropicales, Paris, France; Groupe Hospitalier Paris Saint-Joseph, Equipe Mobile de Microbiologie Clinique, Paris, France.
2Université Paris XII, Hôpital Henri Mondor, Unité de Contrôle Épidémiologique et Prévention de l’Infection, Créteil, France.
3Université Paris Descartes, Hôpital Cochin, Service de Médecine Interne, Paris, France.
4Université Paris Diderot, Hôpital Beaujon, Département d’Anesthésie-Réanimation, Clichy, France.
5Université Paris XII, Hôpital Henri Mondor, Laboratoire de Bactériologie-Hygiène, Département de Virologie, Bactériologie-Hygiène, Parasitologie-Mycologie, Créteil, France.
6Université Paris Descartes, Hôpital Necker Enfants Malades, Laboratoire de Microbiologie, Paris, France.
7Université d’Angers, Unité de Prévention et de Lutte Contre les Infections Nosocomiales, CHU d’Angers, 4 rue Larrey, 49000 Angers, France. Electronic address: JeanRalph.ZAHAR@chu-angers.fr
To avoid the use of carbapenems, alternatives such as cephamycin, piperacillin-tazobactam, and others are suggested for the treatment of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) infections. The aim of this study was to evaluate the frequency and the feasibility of antimicrobial de-escalation for ESBL-PE-related infections.
A prospective observational, bi centric cohort study was conducted. All patients with ESBL-PE infections were included. De-escalation was systematically suggested if patients were clinically stable and the isolate was susceptible to possible alternatives.
Seventy-nine patients were included: 36 (45.6%) were children, 27 (34.1%) were hospitalized in intensive care units, and 37 (47%) were immunocompromised. Urinary tract infections, pneumonia, and catheter-related bloodstream infections accounted for 45.6%, 19%, and 10%, respectively, of the cohort. Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae were the three most frequent causative organisms isolated. On day 5, 47 (59.2%) of the patients were still receiving carbapenems. Antimicrobial resistance (44.7%), infection relapse (26.9%), and clinical instability (19.2%) were the most important reasons for not prescribing alternatives. E. coli-related infections appeared to be a protective factor against maintaining the carbapenem prescription (odds ratio 0.11, 95% confidence interval 0.041-0.324; p=0.0013).
In clinical practice, less than 50% of patients with ESBL-PE-related infections were de-escalated after empirical treatment with carbapenems.
Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Epidemiología, Health Care-Associated Infections, HIC no SIDA, Infecciones asociadas a catater IV, Infecciones nosocomiales, Infecciones respiratorias, Infecciones urinarias, Metodos diagnosticos, Resistencia bacteriana, Sepsis, Update.