Clinical impact and risk factors for colonization with extended-spectrum β-lactamase-producing bacteria in the intensive care unit

Abstract

We found a high prevalence of ESBLE-PE colonization on admission to our ICU, even in the subgroup admitted from the community, but few first infections. Identifying risk factors for ESBL-PE colonization may help identifying which patients may warrant empiric ESBL-targeted antimicrobial drug therapy as a means to limit carbapenem use.

Oral DAV131, a Charcoal-Based Adsorbent, Inhibits Intestinal Colonization by β-Lactam-Resistant Klebsiella pneumoniae in Cefotaxime-Treated Mice

“…This is of particular importance because of the key role of the intestinal microbiota in the emergence and spread of antibiotic resistance. It has recently been unequivocally shown that previous treatment with broad-spectrum cephalosporins is an independent risk factor for intestinal colonization by broad-spectrum-cephalosporin-resistant bacteria in ICU patients and that carriage of such bacteria is associated with episodes of ICU-associated infections (15).…”

“…Indeed, it has been shown in vitro and in vivo in animal models that activated charcoal targeted to the colon was able to reduce exposure of the microbiota to fluoroquinolones during treatments (12)(13)(14). However, whether this approach could also work with broad-spectrum cephalosporins, which are currently a major driver of bacterial resistance to antibiotics (15), has not yet been tested.…”

For control of colonisation with extended-spectrum β-lactamase-producing bacteria, SDD does work

“…It is puzzling to us why 23 years later, Brun-Buisson et al overlooked the one intervention that does work for the control of endemicity and outbreaks of ESBL-PE [4] when writing in their recent report that 'our data suggest that additional measures may be warranted to control the spread of the latter species' [1].…”

“…Dear Editor, We read with interest the French report entitled ''Clinical impact and risk factors for colonization with extended-spectrum b-lactamase-producing bacteria in the intensive care unit'' [1] as we are aware that these researchers have previously reported on this topic. Brun-Buisson et al [2] have an understanding of endemicity and outbreaks of carriage and infection due to extended-spectrum betalactamase-producing Enterobacteriaceae (ESBL-PE).…”

Control of colonisation with extended-spectrum β-lactamase-producing bacteria: reply to Zandstra et al.

“…Dear Editor, We thank Dr Zandstra and colleagues for their interest in our study [1]. First, as they correctly identified, our study focused on a better understanding of the current epidemiology of ESBL-PE in ICUs, and on factors associated with infections due to these multi-drug resistant Gram-negative bacilli (MDR-GNB) in the current context of an increasingly high carriage rate in the hospital or in the community-whether in the Paris area or many other places around the world-in order to help intensivists better targeting, and if possible, contain the increasing empiric use of carbapenems and spiralling resistance.…”