Significance of Prior Digestive Colonization With Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in Patients With Ventilator-Associated Pneumonia*

Rapid identification technologies and phenotypic methods, new therapeutic strategies, and novel treatment paradigms have evolved in an attempt to improve treatment outcomes for VAP; however, clinical data supporting alternative treatment strategies and adjunctive therapies remain sparse. Importantly, new classes of antimicrobials, novel virulence factor inhibitors, and beta-lactam/beta-lactamase inhibitor combinations are currently in development. Conscientious stewardship of new and emerging therapeutic agents will be needed to ensure they remain effective well into the future.

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“…European clinical studies also support the prominent role of P. aeruginosa in VAP (14–19% of cases) [32, 33]. …”

Section: Epidemiology Of Gram-negative Vap Pathogensmentioning

confidence: 86%

Resistance Trends and Treatment Options in Gram-Negative Ventilator-Associated Pneumonia

Rhodes

Cruce

O’Donnell

et al. 2018

Curr Infect Dis Rep

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“…Indeed, previous studies showed that K. pneumoniae infections are associated with more serious illness than E. coli infections [17, 18]. In a recent study, ESBL-PE caused 17 VAP (40%) among patients with prior colonization [19]. The proportion of ICU-acquired ESBL-PE-positive respiratory samples was 34% among colonized patients [20].…”

Section: Discussionmentioning

confidence: 99%

Frequency, associated factors and outcome of multi-drug-resistant intensive care unit-acquired pneumonia among patients colonized with extended-spectrum β-lactamase-producing Enterobacteriaceae

Razazi

Dessap

Carteaux

et al. 2017

Ann. Intensive Care

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Background We assessed prevalence, associated factors and prognosis of extended-spectrum beta-lactamase-producing Enterobacteriaceae pneumonia acquired in intensive care unit (ESBL-PE pneumonia) among carriers. Variables associated with nosocomial pneumonia caused by carbapenem-resistant bacteria (CRB) were also assessed.Methods A 6-year prospective study (May 2009–March 2015) in the medical ICU of an 850-bed university-affiliated hospital was conducted.Results Of the 6303 patients admitted, 843 (13.4%) had ESBL-PE carriage detected. Among carriers, 111 (13%) patients developed ICU-acquired pneumonia of whom 48 (43%) had ESBL-PE pneumonia (6% of carriers). By multivariable analysis, SAPS II at admission >43 [OR 2.81 (1.16–6.79)] and colonization with Enterobacter sp. or K. pneumoniae species [OR 10.96 (2.93–41.0)] were independent predictive factors for ESBL-PE pneumonia in colonized patients, whereas receipt of >2 days of amoxicillin/clavulanic acid during the ICU stay [OR 0.24 (0.08–0.71)] was protective. Patients with ESBL-PE pneumonia had a higher SOFA score (p = 0.037) and more frequent septic shock at pneumonia onset (p = 0.047). However, ESBL-PE pneumonia was not an independent predictor of mortality. Twenty-five patients had pneumonia caused by CRB. Chronic renal insufficiency, administration of third-generation cephalosporin within the past 3 months, acute respiratory distress syndrome before pneumonia and prior therapy with a carbapenem or fluoroquinolones were associated with CRB pneumonia in this selected population.ConclusionsAlthough few ESBL-PE carriers developed ESBL-PE pneumonia overall, a high proportion of pneumonia were caused by ESBL-PE in carriers developing ICUAP. ESBL-PE pneumonia was not an independent predictor of mortality. As pneumonia caused by CRB is increasing, knowledge of factors associated with ESBL-PE or CRB pneumonia may help empiric therapy of pneumonia among ESBL-PE carriers.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0283-4) contains supplementary material, which is available to authorized users.

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“…Several studies suggest that previous colonization and antibiotic therapy are the two most important risk factors associated with ESBL-PE related infection [19,20]. In a study conducted in 587 patients with suspected VAP, 40 patients (6.8%) were colonized with ESBL-PE prior to the development of pneumonia and 20 (3.4%) had VAP caused by this microorganism, of whom 17 were previously colonized with ESBL-PE [21]. Thus, positive and negative predictive values of prior ESBL-PE colonization for predicting ESBL-PE involvement in VAP were 41.5% and 99.4%, respectively, confirming that screening for ESBL-producing GNB digestive colonization by weekly active surveillance cultures could reliably exclude the involvement of such pathogens when rectal and/or tracheal swabs for ESBL-PE are negative.…”

Section: Microbial Etiologies Of Vapmentioning

confidence: 99%

Microbial cause of ICU-acquired pneumonia: hospital-acquired pneumonia versus ventilator-associated pneumonia

Luyt

Hékimian

Koulenti

et al. 2018

Current Opinion in Critical Care

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Significance of Prior Digestive Colonization With Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in Patients With Ventilator-Associated Pneumonia*

Abstract: Screening for extended-spectrum β-lactamase-producing Enterobacteriaceae digestive colonization by weekly active surveillance cultures could reliably exclude the risk of the involvement of such pathogens in patients with ventilator-associated pneumonia in low-prevalence area.

Cited by 34 publications

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Resistance Trends and Treatment Options in Gram-Negative Ventilator-Associated Pneumonia

Resistance Trends and Treatment Options in Gram-Negative Ventilator-Associated Pneumonia

Frequency, associated factors and outcome of multi-drug-resistant intensive care unit-acquired pneumonia among patients colonized with extended-spectrum β-lactamase-producing Enterobacteriaceae

Microbial cause of ICU-acquired pneumonia: hospital-acquired pneumonia versus ventilator-associated pneumonia

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