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20.04.2020 | Original

Semi-quantitative cultures of throat and rectal swabs are efficient tests to predict ESBL-Enterobacterales ventilator-associated pneumonia in mechanically ventilated ESBL carriers

verfasst von: Olivier Andremont, Laurence Armand-Lefevre, Claire Dupuis, Etienne de Montmollin, Stéphane Ruckly, Jean-Christophe Lucet, Roland Smonig, Eric Magalhaes, Etienne Ruppé, Bruno Mourvillier, Jordane Lebut, Mathilde Lermuzeaux, Romain Sonneville, Lila Bouadma, Jean-François Timsit, the COMBACTE net consortium

Erschienen in: Intensive Care Medicine | Ausgabe 6/2020

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Abstract

Purpose

In ICU patients with carriage of extended spectrum beta-lactamase producing Enterobacterales (ESBL-E) and suspected Gram-negative bacilli ventilator-associated pneumonia (GNB-VAP), the quantification of the rectal and throat ESBL-E carriage might predict the ESBL-E involvement in GNB-VAP. Our aim was to evaluate whether a semi-quantitative assessment of rectal/throat ESBL-E carriage can predict ESBL-E-associated VAP in medical ICU patients.

Methods

From May 2014 to May 2017, all ESBL-E carriers had a semi-quantitative assessment of ESBL-E density in swabs cultures. For those who developed GNB-VAP (diagnosed using bronchoalveolar lavage or plugged telescopic catheter with significant quantitative culture), the last positive swab collected at least 48 h before GNB-VAP onset was selected. Clinical data were extracted from a prospectively collected database.

Results

Among 365 ESBL-E carriers, 82 developed 107 episodes of GNB-VAP (ESBL-E VAP, n = 50; and non-ESBL-E GNB-VAP, n = 57) after 13 days of mechanical ventilation in median. Antimicrobials use before VAP onset was similar between groups. The last swabs were collected 5 days in median before VAP onset. ESBL-E. coli carriers developed ESBL-E VAP less frequently (n = 13, 34%) than others (n = 32, 67.3%, p < .01). Throat swab positivity (39 (78%) vs. 12 (23%), p < .01) was more frequent for ESBL-E VAP. ESBL-E VAP was associated with significantly higher ESBL-E density in rectal swabs. In multivariate models, non-E. coli ESBL-E carriage and rectal ESBL-E carriage density, or throat carriage, remained associated with ESBL-E VAP.

Conclusion

In carriers of ESBL-E other than E. coli, ESBL-E throat carriage or a high-density ESBL-E rectal carriage are risk factors of ESBL-E VAP in case of GNB-VAP.

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Titel: Semi-quantitative cultures of throat and rectal swabs are efficient tests to predict ESBL-Enterobacterales ventilator-associated pneumonia in mechanically ventilated ESBL carriers
verfasst von: Olivier Andremont
Laurence Armand-Lefevre
Claire Dupuis
Etienne de Montmollin
Stéphane Ruckly
Jean-Christophe Lucet
Roland Smonig
Eric Magalhaes
Etienne Ruppé
Bruno Mourvillier
Jordane Lebut
Mathilde Lermuzeaux
Romain Sonneville
Lila Bouadma
Jean-François Timsit
the COMBACTE net consortium
Publikationsdatum: 20.04.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 6/2020
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06029-y

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Semi-quantitative cultures of throat and rectal swabs are efficient tests to predict ESBL-Enterobacterales ventilator-associated pneumonia in mechanically ventilated ESBL carriers