Risk factors for carbapenem-resistant Gram-negative bacteremia in intensive care unit patients

Routsi, Christina; Pratikaki, Maria; Platsouka, E.; Sotiropoulou, Christina; Papas, V; Pitsiolis, Theodoros; Tsakris, Athanassios; Nanas, Serafim; Roussos, Charis

doi:10.1007/s00134-013-2914-z

Cited by 46 publications

(43 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is of particular concern because inappropriate EAT leads to higher mortality in the ICU [2]. However, an across-the-board prescription of empirical carbapenems in the most severely ill patients is not acceptable, as the link between carbapenem consumption and the emergence of carbapenemase-producing Enterobacteriaceae or multi-drug resistant non-fermenting GNB is by now well-demonstrated [21–25], even with a short exposure [12]. Thus, the World Health Organization [13] and national plans for controlling antibiotic consumption [26] have encouraged the development of rapid diagnostic tests evaluating bacterial resistance, which should ideally enable both early escalation in the case of inappropriate therapy and early de-escalation in the case of empirical therapy that is too broad-spectrum.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Because the isolates were not available for further analysis, the mechanisms of carbapenem resistance in A. baumannii and P. aeruginosa isolates could not be evaluated. Prolonged hospitalization (25)(26)(27), previous carbapenem use (1,(25)(26)(27)(28)(29)(30), ICU care (25,27,29), and the presence of medical devices (26)(27)(28) are considered risk factors for CR A. baumannii and CR P. aeruginosa colonization. The risk factors for CRGNB were similar to the risk fac- tors for CR A. baumannii and CR P. aeruginosa colonization.…”

Section: Discussionmentioning

confidence: 99%

“…arbapenems, such as meropenem, imipenem, and doripenem, are the currently preferred agents for treating serious bacterial infections caused by multidrug-resistant (MDR) Gram-negative pathogens, such as members of the Enterobacteriaceae producing extended-spectrum ␤-lactamases or AmpC ␤-lactamase, Pseudomonas aeruginosa, and Acinetobacter baumannii (1). With the increasing use of carbapenems, however, carbapenem-resistant (CR) Gram-negative bacteria have become a major concern in health care-associated infections (2).…”

mentioning

confidence: 99%

Clinical Features and Risk Factors for Development of Breakthrough Gram-Negative Bacteremia during Carbapenem Therapy

Lee

Kang

et al. 2016

Antimicrob Agents Chemother

View full text Add to dashboard Cite

bWith the increasing use of carbapenems, carbapenem-resistant Gram-negative bacteria have become a major concern in health care-associated infections. The present study was performed to evaluate the clinical and microbiological features of breakthrough Gram-negative bacteremia (GNB) during carbapenem therapy and to assess risk factors for development of breakthrough GNB. A case-control study was performed at a tertiary hospital from 2005 to 2014. Case patients were defined as individuals whose blood cultures grew Gram-negative bacteria while the patients were receiving carbapenems for at least 48 h before breakthrough GNB. Age-, sex-, and date-matched controls were selected from patients who received carbapenem for at least 48 h and did not develop breakthrough GNB during carbapenem treatment. A total of 101 cases of breakthrough GNB were identified and compared to 100 controls. The causative microorganisms for breakthrough GNB were Stenotrophomonas maltophilia (n ‫؍‬ 33), Acinetobacter baumannii (n ‫؍‬ 32), Pseudomonas aeruginosa (n ‫؍‬ 21), and others (n ‫؍‬ 15). Approximately 90% of S. maltophilia isolates were susceptible to levofloxacin and trimethoprim-sulfamethoxazole. The most common infection types were primary bacteremia (38.6%) and respiratory infections (35.6%). More than half of the patients died within a week after bacteremia, and the 30-day mortality rate was 70.3%. In a multivariate analysis, a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization by causative microorganisms were significantly associated with breakthrough GNB. Our data suggest that S. maltophilia, A. baumannii, and P. aeruginosa are the major pathogens of breakthrough GNB during carbapenem therapy, in association with a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization.C arbapenems, such as meropenem, imipenem, and doripenem, are the currently preferred agents for treating serious bacterial infections caused by multidrug-resistant (MDR) Gram-negative pathogens, such as members of the Enterobacteriaceae producing extended-spectrum ␤-lactamases or AmpC ␤-lactamase, Pseudomonas aeruginosa, and Acinetobacter baumannii (1). With the increasing use of carbapenems, however, carbapenem-resistant (CR) Gram-negative bacteria have become a major concern in health care-associated infections (2). In the United States, more than 23,000 infections caused by MDR A. baumannii, MDR P. aeruginosa, or CR Enterobacteriaceae are reported annually (3). In the Republic of Korea, the incidence of imipenem-resistant A. baumannii infections increased from 43.6% in 2006 to 82.5% in 2010 in intensive care unit (ICU) patients (4).The term "breakthrough bacteremia" is defined as an episode of continuous or new-onset bacteremia in a patient receiving appropriate antibiotics for the microorganism recovered from blood cultures (5-11). In addition to the use of unsuitable antibioticsdue to either resistance of the microorganism (5, ...

show abstract

“…In their excellent study Routsi et al [23] prospectively evaluated 1,096 patients admitted to a 25-bed university ICU in Athens to identify risk factors for acquisition of carbapenem-resistant (CR) gram-negative bacteremia (GNB). Of the 842 evaluable patients, 43 patients developed only gram-positive bacteremia and/or candidemia and 169 developed GNB giving an incidence of 16.3 per 1,000 patient-ICU days, of which 85 patients had bacteremia due to CR isolates.…”

Section: Antimicrobial Resistancementioning

confidence: 99%

Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

et al. 2014

View full text Add to dashboard Cite

Risk factors for carbapenem-resistant Gram-negative bacteremia in intensive care unit patients

Abstract: Among ICU patients, VAP development and the presence of additional intravascular devices were the major risk factors for CR-GNB. In the absence of VAP, prior use of carbapenems was the only factor independently related to carbapenem resistance.

Cited by 46 publications

References 36 publications

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

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

Clinical Features and Risk Factors for Development of Breakthrough Gram-Negative Bacteremia during Carbapenem Therapy

Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics

Contact Info

Product

Resources

About