Tags

Type your tag names separated by a space and hit enter

Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae.
Intensive Care Med. 2018 05; 44(5):616-626.IC

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.

Authors+Show Affiliations

Medical ICU, La Source Hospital, CHR Orléans, Orléans, France.UMR 1137, IAME Team 5, DeSCID: Decision SCiences in Infectious Diseases, Control and Care, INSERM, Paris Diderot, Sorbonne Paris Cité University, Paris, France.Medical ICU, Albert Michallon University Hospital, Grenoble, France.Respiratory and Infectious Diseases ICU, North Hospital, Marseille, France.Medical ICU, Saint-Louis Hospital, APHP, Paris, France.Medical Surgical ICU, Andrée Rosemon Hospital, Cayenne, France.Medical Surgical ICU, Corbeil-Essone Hospital, Corbeil-Essone, France.Medical ICU, Edouard-Herriot University Hospital, Lyon, France.Surgical ICU, Edouard-Herriot University Hospital, Lyon, France.Medical ICU, Charles Nicolle University Hospital, Rouen, France.Medical ICU, Hôtel-Dieu University Hospital, Nantes, France.Medical ICU, Saint-Louis Hospital, APHP, Paris, France.Infection Control Unit, Avicenne Hospital, Bobigny, France.Medical-Surgical ICU, General Hospital, Montfermeil, France.Medical-Surgical ICU, Delafontaine Hospital, Saint-Denis, France.Medical ICU, Gabriel Montpied Hospital, Clermont-Ferrand, France.Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, APHP, 46 Rue Henri-Huchard, 75877, Paris Cedex 18, France.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. Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, APHP, 46 Rue Henri-Huchard, 75877, Paris Cedex 18, France. jean-francois.timsit@aphp.fr.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29663045

Citation

Barbier, François, et al. "Infection-related Ventilator-associated Complications in ICU Patients Colonised With Extended-spectrum Β-lactamase-producing Enterobacteriaceae." Intensive Care Medicine, vol. 44, no. 5, 2018, pp. 616-626.
Barbier F, Bailly S, Schwebel C, et al. Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae. Intensive Care Med. 2018;44(5):616-626.
Barbier, F., Bailly, S., Schwebel, C., Papazian, L., Azoulay, É., Kallel, H., Siami, S., Argaud, L., Marcotte, G., Misset, B., Reignier, J., Darmon, M., Zahar, J. R., Goldgran-Toledano, D., de Montmollin, É., Souweine, B., Mourvillier, B., & Timsit, J. F. (2018). Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae. Intensive Care Medicine, 44(5), 616-626. https://doi.org/10.1007/s00134-018-5154-4
Barbier F, et al. Infection-related Ventilator-associated Complications in ICU Patients Colonised With Extended-spectrum Β-lactamase-producing Enterobacteriaceae. Intensive Care Med. 2018;44(5):616-626. PubMed PMID: 29663045.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae. AU - Barbier,François, AU - Bailly,Sébastien, AU - Schwebel,Carole, AU - Papazian,Laurent, AU - Azoulay,Élie, AU - Kallel,Hatem, AU - Siami,Shidasp, AU - Argaud,Laurent, AU - Marcotte,Guillaume, AU - Misset,Benoît, AU - Reignier,Jean, AU - Darmon,Michaël, AU - Zahar,Jean-Ralph, AU - Goldgran-Toledano,Dany, AU - de Montmollin,Étienne, AU - Souweine,Bertrand, AU - Mourvillier,Bruno, AU - Timsit,Jean-François, AU - ,, Y1 - 2018/04/16/ PY - 2018/02/09/received PY - 2018/03/27/accepted PY - 2018/4/18/pubmed PY - 2018/12/12/medline PY - 2018/4/18/entrez KW - Carbapenem KW - Extended-spectrum beta-lactamase KW - Mechanical ventilation KW - Outcome KW - Ventilator-associated pneumonia SP - 616 EP - 626 JF - Intensive care medicine JO - Intensive Care Med VL - 44 IS - 5 N2 - 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. SN - 1432-1238 UR - https://www.unboundmedicine.com/medline/citation/29663045/Infection_related_ventilator_associated_complications_in_ICU_patients_colonised_with_extended_spectrum_β_lactamase_producing_Enterobacteriaceae_ L2 - https://dx.doi.org/10.1007/s00134-018-5154-4 DB - PRIME DP - Unbound Medicine ER -