Thomas Vauchel1, Romain Pirracchio2, Maïté Chaussard3, Matthieu Lafaurie4, Martine Rouveau5, Clotilde Rousseau5, Mourad Benyamina1, Sabri Soussi1, François Dépret3, Axelle Ferry1, Haikel Oueslati1, Marc Chaouat6, Maurice Mimoun6, Vincent Jarlier7, Nabila Moreno8, Alexandre Mebazaa9, Matthieu Legrand10. 1. AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France. 2. AP-HP, Hôpital Européen Georges Pompidou, Service d'Anesthesie-Reanimation, Paris, France; Service de Biostatistique et Informatique Médicale, INSERM UMR-1153, Equipe ECSTRA, Hôpital Saint-Louis, Sorbonne Paris Cité, Paris, France. 3. AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; Université Paris Diderot, Paris, France. 4. AP-HP, GH St-Louis-Lariboisière, Service de Maladies Infectieuses, Paris, France. 5. AP-HP, GH St-Louis-Lariboisière, Service de Bactériologie, Paris, France. 6. Université Paris Diderot, Paris, France; AP-HP, GH St-Louis-Lariboisière, Plastic Surgery and Burn Unit, Paris, France. 7. AP-HP, Hôpital La Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, Paris, France. 8. Service de biochimie, Hôpital Saint-Louis, Paris, France. 9. AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; Université Paris Diderot, Paris, France; UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; F-CRIN, INICRCT Network, Paris, France. 10. AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; Université Paris Diderot, Paris, France; UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; F-CRIN, INICRCT Network, Paris, France.. Electronic address: matthieu.legrand@aphp.fr.
Abstract
BACKGROUND: Multidrug-resistant (MDR) bacteria outbreaks represent a major threat in intensive care units. Patients may then be exposed to drug-related direct toxicity during such outbreaks. The objective of this study was to explore the impact of an outbreak of imipenem-resistant Acinetobacter baumannii (IR-AB) on renal outcomes. METHODS: We performed a before-and-after observational study in a French burn intensive care unit during an IR-AB outbreak: a 13-month period before (period A, October 2013-October 2014) and a 13-month period after outbreak control (period B, December 2014-December 2015). A total of 409 patients were included, 195 during period A and 214 during period B. The main endpoint was major adverse kidney events at day 90 (MAKE 90). Secondary endpoints were acute kidney injury (AKI) and persistent renal dysfunction. RESULTS: Incidence of MAKE 90 was 15.9% during period A versus 11.2% during period B (P = .166) and AKI 28.2% versus 18.7% (P = .023). The use of colistin was associated with renal outcomes in univariate analysis. After adjustment of potential confounding factors using a targeted Machine Learning Analysis (ie, IR-AB-related infection, septic shock, severity scores, other nephrotoxics, chronic kidney disease, serum creatinine at admission, Staphylococcus aureus), colistin remained associated with the risk of MAKE and AKI (relative risk = 2.909, 95% confidence interval [CI] [1.364, 6.204], P = .006 for MAKE 90, and relative risk = 2.14, 95% CI [1.52, 3.02], P<.0001 for AKI). CONCLUSIONS: The episode of IR-AB outbreak was associated with an increased risk of kidney events, which appears to be driven by the use of colistin.
BACKGROUND: Multidrug-resistant (MDR) bacteria outbreaks represent a major threat in intensive care units. Patients may then be exposed to drug-related direct toxicity during such outbreaks. The objective of this study was to explore the impact of an outbreak of imipenem-resistant Acinetobacter baumannii (IR-AB) on renal outcomes. METHODS: We performed a before-and-after observational study in a French burn intensive care unit during an IR-AB outbreak: a 13-month period before (period A, October 2013-October 2014) and a 13-month period after outbreak control (period B, December 2014-December 2015). A total of 409 patients were included, 195 during period A and 214 during period B. The main endpoint was major adverse kidney events at day 90 (MAKE 90). Secondary endpoints were acute kidney injury (AKI) and persistent renal dysfunction. RESULTS: Incidence of MAKE 90 was 15.9% during period A versus 11.2% during period B (P = .166) and AKI 28.2% versus 18.7% (P = .023). The use of colistin was associated with renal outcomes in univariate analysis. After adjustment of potential confounding factors using a targeted Machine Learning Analysis (ie, IR-AB-related infection, septic shock, severity scores, other nephrotoxics, chronic kidney disease, serum creatinine at admission, Staphylococcus aureus), colistin remained associated with the risk of MAKE and AKI (relative risk = 2.909, 95% confidence interval [CI] [1.364, 6.204], P = .006 for MAKE 90, and relative risk = 2.14, 95% CI [1.52, 3.02], P<.0001 for AKI). CONCLUSIONS: The episode of IR-AB outbreak was associated with an increased risk of kidney events, which appears to be driven by the use of colistin.
Authors: François Dépret; Boris Farny; Mathieu Jeanne; Kada Klouche; Thomas Leclerc; Karine Nouette-Gaulain; Olivier Pantet; Francis Rémerand; Antoine Roquilly; Anne-Françoise Rousseau; Simon Sztajnic; Sandrine Wiramus; Eric Vicaut; Matthieu Legrand Journal: Trials Date: 2020-11-25 Impact factor: 2.279