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Relationship between digestive tract colonization and subsequent ventilator-associated pneumonia related to ESBL-producing Enterobacteriaceae.
PLoS One. 2018; 13(8):e0201688.Plos

Abstract

BACKGROUND

Ventilator-associated pneumonia (VAP) is the most common ICU-acquired infection. Recently, the incidence of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBLE) has substantially increased in critically ill patients. Identifying patients at risk for VAP related to ESBLE could be helpful to improve the rate of appropriate initial antibiotic treatment, and to reduce unnecessary exposure to carbapenems. The primary objective was to identify risk factors for VAP related to ESBLE. Secondary objective was to determine the impact of ESBLE on outcome in VAP patients.

METHODS

This retrospective study was conducted in a single mixed intensive care unit (ICU), during a 4-year period. All patients with confirmed VAP were included. VAP was defined using clinical, radiologic and quantitative microbiological data. VAP first episodes were prospectively identified using the continuous surveillance data. Exposure to different risk factors was taken into account until the diagnosis of ESBLE VAP or until ICU discharge, in patients with ESBLE VAP and VAP related to other bacteria, respectively. In all patients, routine screening for ESBLE (rectal swab) was performed at ICU admission and once a week. Patients with ESBLE VAP were compared with those with VAP related to other bacteria using univariate analysis. All significant factors were included in the multivariate logistic regression model.

RESULTS

Among the 410 patients with VAP, 43 (10.5%) had ESBLE VAP, 76 (19%) patients had polymicrobial VAP and 189 (46%) had VAP related to multidrug resistant bacteria. Multivariate analysis identified prior ESBLE colonization of the digestive tract as the only independent risk factor for ESBLE VAP (OR [95% CI] = 23 [10-55], p < 0.001). Whilst the positive predictive value of ESBLE digestive colonization was low (43.6%), its negative predictive value was excellent (97.3%) in predicting ESBLE VAP. Duration of mechanical ventilation (median [IQR], 28 [18,42] vs 23 [15,42] d, p = 0.4), length of ICU stay (31 [19,53] vs 29 [18,46] d, p = 0.6), and mortality rates (55.8% vs 50%, p = 0.48) were similar in ESBLE VAP, compared with VAP related to other bacteria.

CONCLUSION

Digestive tract colonization related to ESBLE is independently associated with ESBLE VAP. Its excellent negative predictive value suggests that patients without ESBLE colonization should not receive carbapenems as part of their initial empirical treatment to cover ESBLE.

Authors+Show Affiliations

CHU Lille, Critical Care Center, Lille, France. Univ. Lille, Faculty of Medicine, Lille, France.CHU Lille, Critical Care Center, Lille, France.CHU Lille, Critical Care Center, Lille, France.CHU Lille, Critical Care Center, Lille, France. Univ. Lille, Faculty of Medicine, Lille, France.CHU Lille, Critical Care Center, Lille, France.CHU Lille, Critical Care Center, Lille, France. Univ. Lille, Faculty of Medicine, Lille, France.CHU Lille, Critical Care Center, Lille, France.CHU Lille, Centre de Biologie et de Pathologie, Lille, France.CHU Lille, Clinique de Santé Publique, Plateforme d'Aide Méthodologique, Lille, France.CHU Lille, Critical Care Center, Lille, France. Univ. Lille, Faculty of Medicine, Lille, France.CHU Lille, Critical Care Center, Lille, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30089150

Citation

Houard, Marion, et al. "Relationship Between Digestive Tract Colonization and Subsequent Ventilator-associated Pneumonia Related to ESBL-producing Enterobacteriaceae." PloS One, vol. 13, no. 8, 2018, pp. e0201688.
Houard M, Rouzé A, Ledoux G, et al. Relationship between digestive tract colonization and subsequent ventilator-associated pneumonia related to ESBL-producing Enterobacteriaceae. PLoS ONE. 2018;13(8):e0201688.
Houard, M., Rouzé, A., Ledoux, G., Six, S., Jaillette, E., Poissy, J., Préau, S., Wallet, F., Labreuche, J., Nseir, S., & Voisin, B. (2018). Relationship between digestive tract colonization and subsequent ventilator-associated pneumonia related to ESBL-producing Enterobacteriaceae. PloS One, 13(8), e0201688. https://doi.org/10.1371/journal.pone.0201688
Houard M, et al. Relationship Between Digestive Tract Colonization and Subsequent Ventilator-associated Pneumonia Related to ESBL-producing Enterobacteriaceae. PLoS ONE. 2018;13(8):e0201688. PubMed PMID: 30089150.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship between digestive tract colonization and subsequent ventilator-associated pneumonia related to ESBL-producing Enterobacteriaceae. AU - Houard,Marion, AU - Rouzé,Anahita, AU - Ledoux,Geoffrey, AU - Six,Sophie, AU - Jaillette,Emmanuelle, AU - Poissy,Julien, AU - Préau,Sébastien, AU - Wallet,Frédéric, AU - Labreuche,Julien, AU - Nseir,Saad, AU - Voisin,Benoit, Y1 - 2018/08/08/ PY - 2018/02/12/received PY - 2018/07/22/accepted PY - 2018/8/9/entrez PY - 2018/8/9/pubmed PY - 2019/2/5/medline SP - e0201688 EP - e0201688 JF - PloS one JO - PLoS ONE VL - 13 IS - 8 N2 - BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common ICU-acquired infection. Recently, the incidence of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBLE) has substantially increased in critically ill patients. Identifying patients at risk for VAP related to ESBLE could be helpful to improve the rate of appropriate initial antibiotic treatment, and to reduce unnecessary exposure to carbapenems. The primary objective was to identify risk factors for VAP related to ESBLE. Secondary objective was to determine the impact of ESBLE on outcome in VAP patients. METHODS: This retrospective study was conducted in a single mixed intensive care unit (ICU), during a 4-year period. All patients with confirmed VAP were included. VAP was defined using clinical, radiologic and quantitative microbiological data. VAP first episodes were prospectively identified using the continuous surveillance data. Exposure to different risk factors was taken into account until the diagnosis of ESBLE VAP or until ICU discharge, in patients with ESBLE VAP and VAP related to other bacteria, respectively. In all patients, routine screening for ESBLE (rectal swab) was performed at ICU admission and once a week. Patients with ESBLE VAP were compared with those with VAP related to other bacteria using univariate analysis. All significant factors were included in the multivariate logistic regression model. RESULTS: Among the 410 patients with VAP, 43 (10.5%) had ESBLE VAP, 76 (19%) patients had polymicrobial VAP and 189 (46%) had VAP related to multidrug resistant bacteria. Multivariate analysis identified prior ESBLE colonization of the digestive tract as the only independent risk factor for ESBLE VAP (OR [95% CI] = 23 [10-55], p < 0.001). Whilst the positive predictive value of ESBLE digestive colonization was low (43.6%), its negative predictive value was excellent (97.3%) in predicting ESBLE VAP. Duration of mechanical ventilation (median [IQR], 28 [18,42] vs 23 [15,42] d, p = 0.4), length of ICU stay (31 [19,53] vs 29 [18,46] d, p = 0.6), and mortality rates (55.8% vs 50%, p = 0.48) were similar in ESBLE VAP, compared with VAP related to other bacteria. CONCLUSION: Digestive tract colonization related to ESBLE is independently associated with ESBLE VAP. Its excellent negative predictive value suggests that patients without ESBLE colonization should not receive carbapenems as part of their initial empirical treatment to cover ESBLE. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/30089150/Relationship_between_digestive_tract_colonization_and_subsequent_ventilator_associated_pneumonia_related_to_ESBL_producing_Enterobacteriaceae_ L2 - http://dx.plos.org/10.1371/journal.pone.0201688 DB - PRIME DP - Unbound Medicine ER -