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Colonization and infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in ICU patients: what impact on outcomes and carbapenem exposure?
J Antimicrob Chemother. 2016 Apr; 71(4):1088-97.JA

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.

Authors+Show Affiliations

Medical Intensive Care Unit (ICU), La Source Hospital-CHR Orléans, Orléans, France.UMR1137-IAME Inserm, Paris Diderot University, Paris, France.UMR1137-IAME Inserm, Paris Diderot University, Paris, France.Medical-Surgical ICU, Saint-Joseph Hospital Network, Paris, France.Medical ICU, Albert Michallon University Hospital, Grenoble, France.Department of Biostatistics, OUTCOMEREA, Bobigny, France.Surgical ICU, Antoine Béclère University Hospital, Clamart, France.Medical ICU, Saint-Louis University Hospital, Paris, France.Medical and Infectious Diseases ICU, Bichat-Claude Bernard University Hospital, Paris, France.Medical ICU, Avicenne University Hospital, Bobigny, France.Medical ICU, Saint-Etienne University Hospital, Saint-Priest en Jarez, France.Medical ICU, André Mignot Hospital, Versailles, France.Surgical ICU, Edouard Herriot University Hospital, Lyon, France.UMR1137-IAME Inserm, Paris Diderot University, Paris, France Infection Control Unit, Bichat-Claude Bernard University Hospital, Paris, France.Medical ICU, Gabriel Montpied University Hospital, Clermont-Ferrand, France.Infection Control Unit, Angers University Hospital, Angers, France.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.No affiliation info available

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26755492

Citation

Barbier, François, et al. "Colonization and Infection With Extended-spectrum Β-lactamase-producing Enterobacteriaceae in ICU Patients: what Impact On Outcomes and Carbapenem Exposure?" The Journal of Antimicrobial Chemotherapy, vol. 71, no. 4, 2016, pp. 1088-97.
Barbier F, Pommier C, Essaied W, et al. Colonization and infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in ICU patients: what impact on outcomes and carbapenem exposure? J Antimicrob Chemother. 2016;71(4):1088-97.
Barbier, F., Pommier, C., Essaied, W., Garrouste-Orgeas, M., Schwebel, C., Ruckly, S., Dumenil, A. S., Lemiale, V., Mourvillier, B., Clec'h, C., Darmon, M., Laurent, V., Marcotte, G., Lucet, J. C., Souweine, B., Zahar, J. R., & Timsit, J. F. (2016). Colonization and infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in ICU patients: what impact on outcomes and carbapenem exposure? The Journal of Antimicrobial Chemotherapy, 71(4), 1088-97. https://doi.org/10.1093/jac/dkv423
Barbier F, et al. Colonization and Infection With Extended-spectrum Β-lactamase-producing Enterobacteriaceae in ICU Patients: what Impact On Outcomes and Carbapenem Exposure. J Antimicrob Chemother. 2016;71(4):1088-97. PubMed PMID: 26755492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Colonization and infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in ICU patients: what impact on outcomes and carbapenem exposure? AU - Barbier,François, AU - Pommier,Cécile, AU - Essaied,Wafa, AU - Garrouste-Orgeas,Maïté, AU - Schwebel,Carole, AU - Ruckly,Stéphane, AU - Dumenil,Anne-Sylvie, AU - Lemiale,Virginie, AU - Mourvillier,Bruno, AU - Clec'h,Christophe, AU - Darmon,Michaël, AU - Laurent,Virginie, AU - Marcotte,Guillaume, AU - Lucet,Jean-Christophe, AU - Souweine,Bertrand, AU - Zahar,Jean-Ralph, AU - Timsit,Jean-François, AU - ,, Y1 - 2016/01/10/ PY - 2015/09/09/received PY - 2015/11/09/accepted PY - 2016/1/13/entrez PY - 2016/1/13/pubmed PY - 2016/12/15/medline SP - 1088 EP - 97 JF - The Journal of antimicrobial chemotherapy JO - J. Antimicrob. Chemother. VL - 71 IS - 4 N2 - 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. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/26755492/Colonization_and_infection_with_extended_spectrum_β_lactamase_producing_Enterobacteriaceae_in_ICU_patients:_what_impact_on_outcomes_and_carbapenem_exposure L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkv423 DB - PRIME DP - Unbound Medicine ER -