Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study

Abstract

BackgroundRapid diagnostic tests detecting microbial resistance are needed for limiting the duration of inappropriateness of empirical antimicrobial therapy (EAT) in intensive care unit patients, besides reducing the use of broad-spectrum antibiotics. We hypothesized that the betaLACTA® test (BLT) could lead to early increase in the adequacy of antimicrobial therapy.MethodsThis was a case-control study. Sixty-one patients with BLT-guided adaptation of EAT were prospectively included, and then matched with 61 “controls” having similar infection characteristics (community or hospital-acquired, and source of infection), in whom EAT was conventionally adapted to antibiogram results. Endpoints were to compare the proportion of appropriate (primary endpoint) and optimal (secondary endpoint) antimicrobial therapies with each of the two strategies, once microbiological sample culture results were available.ResultsCharacteristics of patients, infections and EAT at inclusion were similar between groups. Nine early escalations of EAT occurred in the BLT-guided adaptation group, reaching 98% appropriateness vs. 77% in the conventional adaptation group (p < 0.01). The BLT reduced the time until escalation of an inappropriate EAT from 50.5 (48–73) to 27 (24–28) hours (p < 0.01). Seventeen early de-escalations occurred in the BLT-guided adaptation group, compared to one in the conventional adaptation group, reducing patients’ exposure to broad-spectrum beta-lactam such as carbapenems. In multivariate analysis, use of the BLT was strongly associated with early appropriate (OR = 18 (3.4–333.8), p = 0.006) and optimal (OR = 35.5 (9.6–231.9), p < 0.001) antimicrobial therapies. Safety parameters were similar between groups.ConclusionsOur study suggests that a BLT-guided adaptation strategy may allow early beta-lactam adaptation from the first 24 hours following the beginning of sepsis management.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1746-6) contains supplementary material, which is available to authorized users.

Controlling the Diffusion of Multidrug-Resistant Organisms in Intensive Care Units

“…83 Early adaptation of antibiotics guided by the result of a chromogenic detection test of resistance showed a reduction of exposure to broad-spectrum β-lactams and a decreased time to appropriate therapy in a case-control French study in the ICU. 84 Reduction of broad-spectrum antimicrobial use will likely result in fewer C. difficile infections, fewer microbiota disturbances, and MDRO infections, but demonstration remains to be done.…”

Emerging strategies for the noninvasive diagnosis of nosocomial pneumonia

“…From a Greek study, the test exhibited excellent sensitivity (96.1%) and specificity (98.5%) for the detection of ESC nonsusceptibility in the 235 clinical isolates, which harboured mainly extended-spectrum β-lactamase (ESBL) and KPC-and NDM-type enzymes [75]. In a recent study, Garnier et al [76], evaluated this as a tool for early escalation or de-escalation of antimicrobial therapy in gram-negative bacterial infections (54% were HAP). Their results showed that the rate of appropriate antimicrobial therapy was about 100% and that there was a significant reduction in the time to antimicrobial change (27 vs 51 h).…”

The next generation of rapid point-of-care testing identification tools for ventilator-associated pneumonia

“…Recently, Garnier et al reported the use of one of these tests, the β-LACTA™ test (BLT, Bio-Rad, Marnes-laCoquette, France), in the early escalation or de-escalation of early antibiotic therapy in ICU patients diagnosed with infections caused by Enterobacteriaceae species (54). Among the 122 patients included in this analysis, 86 (70%) were diagnosed with pneumonia, and the majority of infections were hospital-acquired in this study (66, 54%).…”