Prior Carriage Predicts Intensive Care Unit Infections Caused by Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae

Abstract

Intensive care unit–acquired infection (ICU-AI) and extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE) carriage are a major concern worldwide. Our objective was to investigate the impact of ESBL-PE carriage on ICU-AI. Our study is prospective, observational, and noninterventional. It was conducted over a 5-year period (Jan 2013–Dec 2017) in the medical-surgical intensive care unit of the Cayenne General Hospital (French Amazonia). During the study period, 1,340 patients were included, 271 (20.2%) developed ICU-AI, and 16.2% of these were caused by ESBL-PE. The main sites of ICU-AI were ventilator-associated pneumonia (35.8%) and primary bloodstream infection (29.8%). The main responsible microorganisms were Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae (ESBL-P in 35.8% of isolates), and Enterobacter cloacae (ESBL-P in 29.8% of isolates). Prior ESBL-PE carriage was diagnosed in 27.6% of patients with ICU-AI. In multivariable analysis, the sole factor associated with ESBL-PE as the responsible organism of ICU-AI was ESBL-PE carriage before ICU-AI (P < 0.001; odds ratio: 7.9 95% CI: 3.4-18.9). ESBL-PE carriers (74 patients) developed ICU-AI which was caused by ESBL-PE in 32 cases (43.2%). This proportion of patients carrying ESBL-PE who developed ICU-AI to the same microorganism was 51.2% in ESBL-P K. pneumoniae, 5.6% in ESBL-P Escherichia coli, and 40% in ESBL-P Enterobacter spp. NPV of ESBL-PE carriage to predict ICU-AI caused by ESBL-PE was above 94% and PPV was above 43%. Carriage of ESBL-P K pneumoniae and Enterobacter spp. is a strong predictor of ICU-AI caused by these two microorganisms.

Impact of Antibiotic Consumption on the Acquisition of Extended-Spectrum β-Lactamase Producing Enterobacterales Carriage during the COVID-19 Crisis in French Guiana

“…Due to this high rate of ESBL-PE carriage, we continue screening patients upon admission and weekly during the ICU stay [26]. In the present study, the prevalence of ESBL-PE acquisition was 22.8% during the first period, higher than that observed in the previous study from our unit [25] and 9.2% during the second period. This is probably due to the impact of antibiotics pressure on the ESBL-PE epidemiology.…”

“…ESBL-PE carriage is a major concern in intensive care facilities [24]. In a previous study conducted in our unit, it was found in 27.6% of patients and was acquired during the ICU stay in 19.6% [25]. Additionally, the proportion of patients carrying ESBL-PE who developed ICU-AI to the same microorganism was 51.2% in ESBL-P K. pneumoniae, and 40% in ESBL-P Enterobacter spp.…”

“…Fifty-seven patients were admitted in Period 1 (18.3%) and 254 in Period 2 (81.7%) (Figure 1). The median age was 63 years (53-71), the male patients were 159 (51.1%), and the median SAPS II score was 29 (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). The main registered comorbidities were diabetes mellitus (40.8%) and arterial hypertension (62.1%).…”

“…Additionally, the proportion of patients carrying ESBL-PE who developed ICU-AI to the same microorganism was 51.2% in ESBL-P K. pneumoniae, and 40% in ESBL-P Enterobacter spp. [25]. Due to this high rate of ESBL-PE carriage, we continue screening patients upon admission and weekly during the ICU stay [26].…”

Leveraging the microbiome in the treatment of sepsis: potential pitfalls and new perspectives

“…Andremont et al demonstrated in a multivariate analysis that the carriage of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and the density of ESBL-PE in rectal swabs were associated with a higher risk of ventilator-associated pneumonia (VAP) in mechanically ventilated patients on the ICU [8 ▪ ]. In addition, a novel study in 1340 ICU patients showed that rectal carriage ESBL-PE was predictive of ICU-acquired secondary infection by these same organisms, with negative predictive values and positive predictive values of 94 and 43%, respectively [37]. Finally, an observational study in 64 ICU patients in China identified different microbial endotypes in sepsis, namely ICU endotype 1 (ICU E1), which constituted predominantly by Bacteroides and an unclassified genus of Enterobacteriaceae and ICU endotype II (ICU E2) dominated by Enterococcus.…”