François Barbier1, Sébastien Bailly2, Carole Schwebel3, Laurent Papazian4, Élie Azoulay5, Hatem Kallel6, Shidasp Siami7, Laurent Argaud8, Guillaume Marcotte9, Benoît Misset10, Jean Reignier11, Michaël Darmon5, Jean-Ralph Zahar12, Dany Goldgran-Toledano13, Étienne de Montmollin14, Bertrand Souweine15, Bruno Mourvillier16, Jean-François Timsit17,18. 1. Medical ICU, La Source Hospital, CHR Orléans, Orléans, France. 2. UMR 1137, IAME Team 5, DeSCID: Decision SCiences in Infectious Diseases, Control and Care, INSERM, Paris Diderot, Sorbonne Paris Cité University, Paris, France. 3. Medical ICU, Albert Michallon University Hospital, Grenoble, France. 4. Respiratory and Infectious Diseases ICU, North Hospital, Marseille, France. 5. Medical ICU, Saint-Louis Hospital, APHP, Paris, France. 6. Medical Surgical ICU, Andrée Rosemon Hospital, Cayenne, France. 7. Medical Surgical ICU, Corbeil-Essone Hospital, Corbeil-Essone, France. 8. Medical ICU, Edouard-Herriot University Hospital, Lyon, France. 9. Surgical ICU, Edouard-Herriot University Hospital, Lyon, France. 10. Medical ICU, Charles Nicolle University Hospital, Rouen, France. 11. Medical ICU, Hôtel-Dieu University Hospital, Nantes, France. 12. Infection Control Unit, Avicenne Hospital, Bobigny, France. 13. Medical-Surgical ICU, General Hospital, Montfermeil, France. 14. Medical-Surgical ICU, Delafontaine Hospital, Saint-Denis, France. 15. Medical ICU, Gabriel Montpied Hospital, Clermont-Ferrand, France. 16. Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, APHP, 46 Rue Henri-Huchard, 75877, Paris Cedex 18, France. 17. UMR 1137, IAME Team 5, DeSCID: Decision SCiences in Infectious Diseases, Control and Care, INSERM, Paris Diderot, Sorbonne Paris Cité University, Paris, France. jean-francois.timsit@aphp.fr. 18. Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, APHP, 46 Rue Henri-Huchard, 75877, Paris Cedex 18, France. jean-francois.timsit@aphp.fr.
Abstract
PURPOSE: To investigate the clinical significance of infection-related ventilator-associated complications (IVAC) and their impact on carbapenem consumption in mechanically ventilated (MV) patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE). METHODS: Inception cohort study from the French prospective multicenter OUTCOMEREA database (17 ICUs, 1997-2015) including all ESBLE carriers (systematic rectal swabbing at admission then weekly and/or urinary or superficial surgical site colonisation) with MV duration > 48 h and ≥ 1 episode of IVAC after carriage documentation. All ICU-acquired infections were microbiologically documented. RESULTS: The 318 enrolled ESBLE carriers (median age 68 years; males 67%; medical admission 68%; imported carriage 53%) experienced a total of 576 IVAC comprising 361 episodes (63%) without documented infection, 124 (21%) related to infections other than ventilator-associated pneumonia (VAP), 73 (13%) related to non-ESBLE VAP and 18 (3%) related to ESBLE VAP. Overall, ESBLE infections accounted for only 43 episodes (7%). Carbapenem exposure within the preceding 3 days was the sole independent predictor of ESBLE infection as the causative event of IVAC, with a protective effect (adjusted odds ratio 0.2, 95% confidence interval 0.05-0.6; P < 0.01). Carbapenems were initiated in 9% of IVAC without infection, 15% of IVAC related to non-VAP infections, 42% of IVAC related to non-ESBLE VAP, and 56% of IVAC related to ESBLE VAP (ESBLE VAP versus non-ESBLE VAP: P = 0.43). CONCLUSIONS: IVAC in ESBLE carriers mostly reflect noninfectious events but act as a strong driver of empirical carbapenem consumption. ESBLE infections are scarce yet hard to predict, strengthening the need for novel diagnostic approaches and carbapenem-sparing alternatives.
PURPOSE: To investigate the clinical significance of infection-related ventilator-associated complications (IVAC) and their impact on carbapenem consumption in mechanically ventilated (MV) patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE). METHODS: Inception cohort study from the French prospective multicenter OUTCOMEREA database (17 ICUs, 1997-2015) including all ESBLE carriers (systematic rectal swabbing at admission then weekly and/or urinary or superficial surgical site colonisation) with MV duration > 48 h and ≥ 1 episode of IVAC after carriage documentation. All ICU-acquired infections were microbiologically documented. RESULTS: The 318 enrolled ESBLE carriers (median age 68 years; males 67%; medical admission 68%; imported carriage 53%) experienced a total of 576 IVAC comprising 361 episodes (63%) without documented infection, 124 (21%) related to infections other than ventilator-associated pneumonia (VAP), 73 (13%) related to non-ESBLE VAP and 18 (3%) related to ESBLE VAP. Overall, ESBLE infections accounted for only 43 episodes (7%). Carbapenem exposure within the preceding 3 days was the sole independent predictor of ESBLE infection as the causative event of IVAC, with a protective effect (adjusted odds ratio 0.2, 95% confidence interval 0.05-0.6; P < 0.01). Carbapenems were initiated in 9% of IVAC without infection, 15% of IVAC related to non-VAP infections, 42% of IVAC related to non-ESBLE VAP, and 56% of IVAC related to ESBLE VAP (ESBLE VAP versus non-ESBLE VAP: P = 0.43). CONCLUSIONS:IVAC in ESBLE carriers mostly reflect noninfectious events but act as a strong driver of empirical carbapenem consumption. ESBLE infections are scarce yet hard to predict, strengthening the need for novel diagnostic approaches and carbapenem-sparing alternatives.
Authors: P Grohs; I Podglajen; E Guerot; F Bellenfant; A Caumont-Prim; G Kac; B Tillecovidin; E Carbonnelle; G Chatellier; G Meyer; J Y Fagon; L Gutmann Journal: Clin Microbiol Infect Date: 2014-07-25 Impact factor: 8.067
Authors: Matteo Bassetti; Jan J De Waele; Philippe Eggimann; Josè Garnacho-Montero; Gunnar Kahlmeter; Francesco Menichetti; David P Nicolau; Jose Arturo Paiva; Mario Tumbarello; Tobias Welte; Mark Wilcox; Jean Ralph Zahar; Garyphallia Poulakou Journal: Intensive Care Med Date: 2015-03-20 Impact factor: 17.440
Authors: Marin H Kollef; Andrew F Shorr; Matteo Bassetti; Jean-Francois Timsit; Scott T Micek; Andrew P Michelson; Jose Garnacho-Montero Journal: Crit Care Date: 2021-10-15 Impact factor: 9.097