nach oben

Erschienen in:

16.04.2018 | Original

Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae

verfasst von: François Barbier, Sébastien Bailly, Carole Schwebel, Laurent Papazian, Élie Azoulay, Hatem Kallel, Shidasp Siami, Laurent Argaud, Guillaume Marcotte, Benoît Misset, Jean Reignier, Michaël Darmon, Jean-Ralph Zahar, Dany Goldgran-Toledano, Étienne de Montmollin, Bertrand Souweine, Bruno Mourvillier, Jean-François Timsit, for the OUTCOMEREA Study Group

Erschienen in: Intensive Care Medicine | Ausgabe 5/2018

Einloggen, um Zugang zu erhalten

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.

Nur mit Berechtigung zugänglich

Bassetti M, De Waele JJ, Eggimann P, Garnacho-Montero J, Kahlmeter G, Menichetti F, Nicolau DP, Paiva JA, Tumbarello M, Welte T, Wilcox M, Zahar JR, Poulakou G (2015) Preventive and therapeutic strategies in critically ill patients with highly resistant bacteria. Intensive Care Med 41(5):776–795CrossRefPubMed

Ruppé E, Woerther PL, Barbier F (2015) Mechanisms of antimicrobial resistance in Gram-negative bacilli. Ann Intensive Care 5:21CrossRefPubMedCentral

Detsis M, Karanika S, Mylonakis E (2017) ICU acquisition rate, risk factors, and clinical significance of digestive tract colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae: a systematic review and meta-analysis. Crit Care Med 45(4):705–714CrossRefPubMed

Bretonniere C, Leone M, Milesi C, Allaouchiche B, Armand-Lefevre L, Baldesi O, Bouadma L, Decre D, Figueiredo S, Gauzit R, Guery B, Joram N, Jung B, Lasocki S, Lepape A, Lesage F, Pajot O, Philippart F, Souweine B, Tattevin P, Timsit JF, Vialet R, Zahar JR, Misset B, Bedos JP (2015) Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric). Intensive Care Med 41(7):1181–1196CrossRefPubMed

Barbier F, Pommier C, Essaied W, Garrouste-Orgeas M, Schwebel C, Ruckly S, Dumenil AS, Lemiale V, Mourvillier B, Clec’h C, Darmon M, Laurent V, Marcotte G, Lucet JC, Souweine B, Zahar JR, Timsit JF (2016) Colonization and infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in ICU patients: what impact on outcomes and carbapenem exposure? J Antimicrob Chemother 71(4):1088–1097CrossRefPubMed

Armand-Lefevre L, Angebault C, Barbier F, Hamelet E, Defrance G, Ruppé E, Bronchard R, Lepeule R, Lucet JC, El Mniai A, Wolff M, Montravers P, Plesiat P, Andremont A (2013) Emergence of imipenem-resistant Gram-negative bacilli in intestinal flora of intensive care patients. Antimicrob Agents Chemother 57(3):1488–1495CrossRefPubMedPubMedCentral

Razazi K, Mekontso Dessap A, Carteaux G, Jansen C, Decousser JW, de Prost N, Brun-Buisson C (2017) Frequency, associated factors and outcome of multi-drug-resistant intensive care unit-acquired pneumonia among patients colonized with extended-spectrum beta-lactamase-producing Enterobacteriaceae. Ann Intensive Care 7(1):61CrossRefPubMedPubMedCentral

Gauzit R, Pean Y, Alfandari S, Bru JP, Bedos JP, Rabaud C, Robert J (2015) Carbapenem use in French hospitals: a nationwide survey at the patient level. Int J Antimicrob Agents 46(6):707–712CrossRefPubMed

Bassi GL, Ferrer M, Marti JD, Comaru T, Torres A (2014) Ventilator-associated pneumonia. Semin Respir Crit Care Med 35(4):469–481CrossRefPubMed

10.

Nussenblatt V, Avdic E, Berenholtz S, Daugherty E, Hadhazy E, Lipsett PA, Maragakis LL, Perl TM, Speck K, Swoboda SM, Ziai W, Cosgrove SE (2014) Ventilator-associated pneumonia: overdiagnosis and treatment are common in medical and surgical intensive care units. Infect Control Hosp Epidemiol 35(3):278–284CrossRefPubMed

11.

Magill SS, Klompas M, Balk R, Burns SM, Deutschman CS, Diekema D, Fridkin S, Greene L, Guh A, Gutterman D, Hammer B, Henderson D, Hess D, Hill NS, Horan T, Kollef M, Levy M, Septimus E, Vanantwerpen C, Wright D, Lipsett P (2013) Developing a new, national approach to surveillance for ventilator-associated events: executive summary. Clin Infect Dis 57(12):1742–1746CrossRefPubMedPubMedCentral

12.

O’Horo JC, Kashyap R, Sevilla Berrios R, Herasevich V, Sampathkumar P (2016) Differentiating infectious and noninfectious ventilator-associated complications: a new challenge. Am J Infect Control 44(6):661–665CrossRefPubMedPubMedCentral

13.

Bouadma L, Sonneville R, Garrouste-Orgeas M, Darmon M, Souweine B, Voiriot G, Kallel H, Schwebel C, Goldgran-Toledano D, Dumenil AS, Argaud L, Ruckly S, Jamali S, Planquette B, Adrie C, Lucet JC, Azoulay E, Timsit JF (2015) Ventilator-associated events: prevalence, outcome, and relationship with ventilator-associated pneumonia. Crit Care Med 43(9):1798–1806CrossRefPubMed

14.

Boyer AF, Schoenberg N, Babcock H, McMullen KM, Micek ST, Kollef MH (2015) A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions. Chest 147(1):68–81CrossRefPubMed

15.

Barbier F, Bailly S, Schwebel C, Forel JM, Azoulay E, Misset B, Mourvillier B, Reignier J, Darmon M, Zahar JR, Goldgran-Toledano D, de Montmollin E, Souweine B, Timsit JF, OUTCOMEREA Study Group. Infection-related ventilator-associated complications in critically ill patients colonized with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE): correlation with ventilator-associated pneumonia due to ESBLE and impact on carbapenem exposure (abstract #0944). In: Lives 2017—annuel conference of the European Society of Intensive Care Medicine, Vienna, Austria; 2017.

16.

Chastre J, Luyt CE (2016) Does this patient have VAP? Intensive Care Med 42(7):1159–1163CrossRefPubMed

17.

Weiss E, Zahar JR, Lesprit P, Ruppe E, Leone M, Chastre J, Lucet JC, Paugam-Burtz C, Brun-Buisson C, Timsit JF (2015) Elaboration of a consensual definition of de-escalation allowing a ranking of beta-lactams. Clin Microbiol Infect 21(7):649 (e1–10) CrossRefPubMed

18.

Razazi K, Derde LP, Verachten M, Legrand P, Lesprit P, Brun-Buisson C (2012) Clinical impact and risk factors for colonization with extended-spectrum beta-lactamase-producing bacteria in the intensive care unit. Intensive Care Med 38(11):1769–1778CrossRefPubMed

19.

Grohs P, Podglajen I, Guerot E, Bellenfant F, Caumont-Prim A, Kac G, Tillecovidin B, Carbonnelle E, Chatellier G, Meyer G, Fagon JY, Gutmann L (2014) Assessment of five screening strategies for optimal detection of carriers of third-generation cephalosporin-resistant Enterobacteriaceae in intensive care units using daily sampling. Clin Microbiol Infect 20(11):O879–O886CrossRefPubMed

20.

Carbonne H, Le Dorze M, Bourrel AS, Poupet H, Poyart C, Cambau E, Mira JP, Charpentier J, Amarsy R (2017) Relation between presence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in systematic rectal swabs and respiratory tract specimens in ICU patients. Ann Intensive Care 7(1):13CrossRefPubMedPubMedCentral

21.

Woerther PL, Burdet C, Chachaty E, Andremont A (2013) Trends in human fecal carriage of extended-spectrum beta-lactamases in the community: toward the globalization of CTX-M. Clin Microbiol Rev 26(4):744–758CrossRefPubMedPubMedCentral

22.

Masse J, Elkalioubie A, Blazejewski C, Ledoux G, Wallet F, Poissy J, Preau S, Nseir S (2017) Colonization pressure as a risk factor of ICU-acquired multidrug resistant bacteria: a prospective observational study. Eur J Clin Microbiol Infect Dis 36(5):797–805CrossRefPubMed

23.

Gurieva T, Dautzenberg MJD, Gniadkowski M, Derde LPJ, Bonten MJM, Bootsma MCJ (2017) The transmissibility of antibiotic-resistant Enterobacteriaceae in intensive care units. Clin Infect Dis. https://doi.org/10.1093/cid/cix825 PubMedCentralCrossRef

24.

Rottier WC, Ammerlaan HS, Bonten MJM (2012) Effects of confounders and intermediates on the association of bacteraemia caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae and patient outcome: a meta-analysis. J Antimicrob Chemother 67(6):1311–1320CrossRefPubMed

25.

Schwaber MJ, Carmeli Y (2007) Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 60(5):913–920CrossRefPubMed

26.

de Kraker ME, Wolkewitz M, Davey PG, Koller W, Berger J, Nagler J, Icket C, Kalenic S, Horvatic J, Seifert H, Kaasch A, Paniara O, Argyropoulou A, Bompola M, Smyth E, Skally M, Raglio A, Dumpis U, Melbarde Kelmere A, Borg M, Xuereb D, Ghita MC, Noble M, Kolman J, Grabljevec S, Turner D, Lansbury L, Grundmann H (2011) Burden of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins. J Antimicrob Chemother 66(2):398–407CrossRefPubMed

27.

Bruyere R, Vigneron C, Bador J, Aho S, Toitot A, Quenot JP, Prin S, Emmanuel Charles P (2016) Significance of prior digestive colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae in patients with ventilator-associated pneumonia. Crit Care Med 44(4):699–706PubMed

28.

Fan Y, Gao F, Wu Y, Zhang J, Zhu M, Xiong L (2016) Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis. Crit Care 20(1):338CrossRefPubMedPubMedCentral

29.

Vodovar D, Marcadié G, Rousseau H, Raskine L, Vicaut E, Deye N, Baud FJ, Mégarbane B (2014) Predictive factors for extended-spectrum beta-lactamase producing Enterobacteriaceae causing infection among ICU patients with prior colonization. Infection 42(4):743–748CrossRefPubMed

30.

Miliani K, L’Heriteau F, Lacave L, Carbonne A, Astagneau P (2011) Imipenem and ciprofloxacin consumption as factors associated with high incidence rates of resistant Pseudomonas aeruginosa in hospitals in northern France. J Hosp Infect 77(4):343–347CrossRefPubMed

31.

Cohen J, Vincent JL, Adhikari NK, Machado FR, Angus DC, Calandra T, Jaton K, Giulieri S, Delaloye J, Opal S, Tracey K, van der Poll T, Pelfrene E (2015) Sepsis: a roadmap for future research. Lancet Infect Dis 15(5):581–614CrossRefPubMed

32.

Le Dorze M, Gault N, Foucrier A, Ruppe E, Mourvillier B, Woerther PL, Birgand G, Montravers P, Dilly MP, Tubach F, Andremont A, Timsit JF, Wolff M, Armand-Lefevre L (2015) Performance and impact of a rapid method combining mass spectrometry and direct antimicrobial susceptibility testing on treatment adequacy of patients with ventilator-associated pneumonia. Clin Microbiol Infect 21(5):468 (e1–6) CrossRefPubMed

33.

Kollef MH, Burnham CD (2017) Ventilator-associated pneumonia: the role of emerging diagnostic technologies. Semin Respir Crit Care Med 38(3):253–263CrossRefPubMed

34.

Ruppé E, Lixandru B, Cojocaru R, Buke C, Paramythiotou E, Angebault C, Visseaux C, Djuikoue I, Erdem E, Burduniuc O, El Mniai A, Marcel C, Perrier M, Kesteman T, Clermont O, Denamur E, Armand-Lefevre L, Andremont A (2013) Relative fecal abundance of extended-spectrum-beta-lactamase-producing Escherichia coli strains and their occurrence in urinary tract infections in women. Antimicrob Agents Chemother 57(9):4512–4517CrossRefPubMedPubMedCentral

35.

Harris PN, Tambyah PA, Paterson DL (2015) Beta-lactam and beta-lactamase inhibitor combinations in the treatment of extended-spectrum beta-lactamase producing Enterobacteriaceae: time for a reappraisal in the era of few antibiotic options? Lancet Infect Dis 15(4):475–485CrossRefPubMed

36.

Gutierrez-Gutierrez B, Perez-Galera S, Salamanca E, de Cueto M, Calbo E, Almirante B, Viale P, Oliver A, Pintado V, Gasch O, Martinez-Martinez L, Pitout J, Akova M, Pena C, Molina J, Hernandez A, Venditti M, Prim N, Origuen J, Bou G, Tacconelli E, Tumbarello M, Hamprecht A, Giamarellou H, Almela M, Perez F, Schwaber MJ, Bermejo J, Lowman W, Hsueh PR, Mora-Rillo M, Natera C, Souli M, Bonomo RA, Carmeli Y, Paterson DL, Pascual A, Rodriguez-Bano J (2016) A multinational, preregistered cohort study of beta-lactam/beta-lactamase inhibitor combinations for treatment of bloodstream infections due to extended-spectrum-beta-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 60(7):4159–4169CrossRefPubMedPubMedCentral

37.

Guet-Revillet H, Tomini E, Emirian A, Join-Lambert O, Lecuyer H, Zahar JR, Jullien V (2017) Piperacillin/tazobactam as an alternative antibiotic therapy to carbapenems in the treatment of urinary tract infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae: an in silico pharmacokinetic study. Int J Antimicrob Agents 49(1):62–66CrossRefPubMed

38.

Timsit JF, Pilmis B, Zahar JR (2017) How should we treat hospital-acquired and ventilator-associated pneumonia caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae? Semin Respir Crit Care Med 38(3):287–300CrossRefPubMed

39.

Torres A, Zhong N, Pachl J, Timsit JF, Kollef M, Chen Z, Song J, Taylor D, Laud PJ, Stone GG, Chow JW (2017) Ceftazidime-avibactam versus meropenem in nosocomial pneumonia, including ventilator-associated pneumonia (REPROVE): a randomised, double-blind, phase 3 non-inferiority trial. Lancet Infect Dis. https://doi.org/10.1016/s1473-3099(17)30747-8 PubMedCrossRef

40.

Wright H, Bonomo RA, Paterson DL (2017) New agents for the treatment of infections with Gram-negative bacteria: restoring the miracle or false dawn? Clin Microbiol Infect 23(10):704–712CrossRefPubMed

Titel: Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae
verfasst von: François Barbier
Sébastien Bailly
Carole Schwebel
Laurent Papazian
Élie Azoulay
Hatem Kallel
Shidasp Siami
Laurent Argaud
Guillaume Marcotte
Benoît Misset
Jean Reignier
Michaël Darmon
Jean-Ralph Zahar
Dany Goldgran-Toledano
Étienne de Montmollin
Bertrand Souweine
Bruno Mourvillier
Jean-François Timsit
for the OUTCOMEREA Study Group
Publikationsdatum: 16.04.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 5/2018
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5154-4

Neu im Fachgebiet AINS

23.04.2024 | Appendizitis | Nachrichten

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae

Abstract

Purpose

Methods

Results

Conclusions

Neu im Fachgebiet AINS

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Update AINS

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2018

Driving airway and transpulmonary pressure are correlated to VILI determinants during controlled ventilation

What’s new in trace elements?

Palliative cares and the intensivist: not confined to the intensive care unit

Should all ICU clinicians regularly be tested for burnout? We are not sure

Acute ischemia of the thumb caused by radial artery cannulation

Brownout: another threat to ICU physicians and nurses

Neu im Fachgebiet AINS

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Update AINS