François Barbier1, Cécile Pommier2, Wafa Essaied2, Maïté Garrouste-Orgeas3, Carole Schwebel4, Stéphane Ruckly5, Anne-Sylvie Dumenil6, Virginie Lemiale7, Bruno Mourvillier8, Christophe Clec'h9, Michaël Darmon10, Virginie Laurent11, Guillaume Marcotte12, Jean-Christophe Lucet13, Bertrand Souweine14, Jean-Ralph Zahar15, Jean-François Timsit16. 1. Medical Intensive Care Unit (ICU), La Source Hospital-CHR Orléans, Orléans, France. 2. UMR1137-IAME Inserm, Paris Diderot University, Paris, France. 3. Medical-Surgical ICU, Saint-Joseph Hospital Network, Paris, France. 4. Medical ICU, Albert Michallon University Hospital, Grenoble, France. 5. Department of Biostatistics, OUTCOMEREA, Bobigny, France. 6. Surgical ICU, Antoine Béclère University Hospital, Clamart, France. 7. Medical ICU, Saint-Louis University Hospital, Paris, France. 8. Medical and Infectious Diseases ICU, Bichat-Claude Bernard University Hospital, Paris, France. 9. Medical ICU, Avicenne University Hospital, Bobigny, France. 10. Medical ICU, Saint-Etienne University Hospital, Saint-Priest en Jarez, France. 11. Medical ICU, André Mignot Hospital, Versailles, France. 12. Surgical ICU, Edouard Herriot University Hospital, Lyon, France. 13. UMR1137-IAME Inserm, Paris Diderot University, Paris, France Infection Control Unit, Bichat-Claude Bernard University Hospital, Paris, France. 14. Medical ICU, Gabriel Montpied University Hospital, Clermont-Ferrand, France. 15. Infection Control Unit, Angers University Hospital, Angers, France. 16. UMR1137-IAME Inserm, Paris Diderot University, Paris, France Medical and Infectious Diseases ICU, Bichat-Claude Bernard University Hospital, Paris, France jean-francois.timsit@bch.aphp.fr.
Abstract
OBJECTIVES: It remains uncertain whether colonization and infection with ESBL-producing Enterobacteriaceae (ESBL-PE) affect the outcomes for ICU patients. Our objectives were to measure the effects of ESBL-PE carriage and infection on mortality, ICU length of stay (LOS) and carbapenem exposure in this population. METHODS: A cause-specific hazard model based on prospectively collected data was built to assess the impact of ESBL-PE colonization and infection on competing risks of death and ICU discharge at day 28 in a multicentre cohort of ICU patients. Carbapenem exposure during the ICU stay was compared between infected carriers, uninfected carriers and non-carriers. RESULTS: Among the 16,734 included patients, 594 (3.5%) were ESBL-PE carriers, including 98 (16.4%) with one or more ESBL-PE infections during the ICU stay. After adjustment for baseline and time-dependent confounders, ESBL-PE infections increased the probability of death at day 28 [adjusted cause-specific hazard ratio (aCSHR), 1.825, 95% CI 1.235-2.699, P = 0.0026] and the ICU LOS (aCSHR for discharge alive at day 28, 0.563, 95% CI 0.432-0.733, P < 0.0001). ESBL-PE carriage without infection extended the LOS (aCSHR, 0.623, 95% CI, 0.553-0.702, P < 0.0001), without affecting mortality (aCSHR, 0.906, 95% CI, 0.722-1.136, P = 0.3916). Carbapenem exposure increased in both infected and uninfected carriers when compared with non-carriers (627, 241 and 69 carbapenem days per 1000 patient days, respectively, P < 0.001). CONCLUSIONS: ESBL-PE infections increased carbapenem consumption, LOS and day 28 mortality. ESBL-PE infections were rather infrequent in carriers; however, even ESBL-PE carriage without infection increased carbapenem exposure and delayed discharge, thereby amplifying the selective pressure and the colonization pressure in the ICU.
OBJECTIVES: It remains uncertain whether colonization and infection with ESBL-producing Enterobacteriaceae (ESBL-PE) affect the outcomes for ICU patients. Our objectives were to measure the effects of ESBL-PE carriage and infection on mortality, ICU length of stay (LOS) and carbapenem exposure in this population. METHODS: A cause-specific hazard model based on prospectively collected data was built to assess the impact of ESBL-PE colonization and infection on competing risks of death and ICU discharge at day 28 in a multicentre cohort of ICU patients. Carbapenem exposure during the ICU stay was compared between infected carriers, uninfected carriers and non-carriers. RESULTS: Among the 16,734 included patients, 594 (3.5%) were ESBL-PE carriers, including 98 (16.4%) with one or more ESBL-PE infections during the ICU stay. After adjustment for baseline and time-dependent confounders, ESBL-PE infections increased the probability of death at day 28 [adjusted cause-specific hazard ratio (aCSHR), 1.825, 95% CI 1.235-2.699, P = 0.0026] and the ICU LOS (aCSHR for discharge alive at day 28, 0.563, 95% CI 0.432-0.733, P < 0.0001). ESBL-PE carriage without infection extended the LOS (aCSHR, 0.623, 95% CI, 0.553-0.702, P < 0.0001), without affecting mortality (aCSHR, 0.906, 95% CI, 0.722-1.136, P = 0.3916). Carbapenem exposure increased in both infected and uninfected carriers when compared with non-carriers (627, 241 and 69 carbapenem days per 1000 patient days, respectively, P < 0.001). CONCLUSIONS: ESBL-PE infections increased carbapenem consumption, LOS and day 28 mortality. ESBL-PE infections were rather infrequent in carriers; however, even ESBL-PE carriage without infection increased carbapenem exposure and delayed discharge, thereby amplifying the selective pressure and the colonization pressure in the ICU.
Authors: Jan J De Waele; Murat Akova; Massimo Antonelli; Rafael Canton; Jean Carlet; Daniel De Backer; George Dimopoulos; José Garnacho-Montero; Jozef Kesecioglu; Jeffrey Lipman; Mervyn Mer; José-Artur Paiva; Mario Poljak; Jason A Roberts; Jesus Rodriguez Bano; Jean-François Timsit; Jean-Ralph Zahar; Matteo Bassetti Journal: Intensive Care Med Date: 2017-12-29 Impact factor: 17.440
Authors: L Surgers; A Boyd; P-Y Boelle; V Lalande; P-A Jolivot; P-M Girard; G Arlet; C Cambier; A Homor; D Decre; J-L Meynard Journal: Eur J Clin Microbiol Infect Dis Date: 2017-02-08 Impact factor: 3.267