Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care - An analysis of the OUTCOMEREA database
Critical Care, Volume 23, No. 1, Article 307, Year 2019
Notification
URL copied to clipboard!
Description
Introduction: Enterococcus species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subjected to debate, except in septic shock. The aim of our study was to evaluate whether an IAT that did not cover Enterococcus spp. was associated with 30-day mortality in ICU patients presenting with IAI growing with Enterococcus spp. Material and methods: Retrospective analysis of French database OutcomeRea from 1997 to 2016. We included all patients with IAI with a peritoneal sample growing with Enterococcus. Primary endpoint was 30-day mortality. Results: Of the 1017 patients with IAI, 76 (8%) patients were included. Thirty-day mortality in patients with inadequate IAT against Enterococcus was higher (7/18 (39%) vs 10/58 (17%), p = 0.05); however, the incidence of postoperative complications was similar. Presence of Enterococcus spp. other than E. faecalis alone was associated with a significantly higher mortality, even greater when IAT was inadequate. Main risk factors for having an Enterococcus other than E. faecalis alone were as follows: SAPS score on day 0, ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI especially with third-generation cephalosporins. Univariate analysis found a higher hazard ratio of death with an Enterococcus other than E. faecalis alone that had an inadequate IAT (HR = 4.4 [1.3-15.3], p = 0.019) versus an adequate IAT (HR = 3.1 [1.0-10.0], p = 0.053). However, after adjusting for confounders (i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and adequacy of IAT for other germs), the impact of the adequacy of IAT was no longer significant in multivariate analysis. Septic shock at diagnosis and ICU-acquired IAI were prognostic factors. Conclusion: An IAT which does not cover Enterococcus is associated with an increased 30-day mortality in ICU patients presenting with an IAI growing with Enterococcus, especially when it is not an E. faecalis alone. It seems reasonable to use an IAT active against Enterococcus in severe postoperative ICU-acquired IAI, especially when a third-generation cephalosporin has been used within 3 months. © 2019 The Author(s).
Authors & Co-Authors
Morvan, Anne Cécile
France, Lyon
Chu de Lyon
Garrouste-Orgeas, Maïté
France, Paris
Groupe Hospitalier Paris Saint-joseph
Ruckly, Stéphane
France, Paris
Inserm
Argaud, Laurent
France, Lyon
Chu de Lyon
Rimmelé, Thomas
France, Lyon
Chu de Lyon
Azoulay, Elie
France, Paris
Centre de Recherche Epidémiologiques et Bio Statistiques de Sorbonne Paris Cité Cress
Dupuis, Claire
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Mourvillier, Bruno H.
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Schwebel, Carole
France, Saint Martin D'heres
Université Grenoble Alpes
Timsit, Jéan-François Franc¸ois
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Zahar, Jean Ralph
Unknown Affiliation
Darmon, Michaël
Unknown Affiliation
Clec'H, Christophe
Unknown Affiliation
Alberti, Corinne
Unknown Affiliation
Bailly, Sébastien D.Sign©bastien
Unknown Affiliation
Hernu, Romain
Unknown Affiliation
Adrie, Christophe
Unknown Affiliation
Allaouchiche, Bernard
Unknown Affiliation
Barbier, François S.
Unknown Affiliation
Bouadma, Lila
Unknown Affiliation
Cheval, Christine
Unknown Affiliation
Cour, Martin
Unknown Affiliation
De Montmollin, E.
Unknown Affiliation
Dumenil, Anne Sylvie
Unknown Affiliation
Kallel, Hatem
Unknown Affiliation
Lautrette, Alexandre
Unknown Affiliation
Misset, Benoıˆt Y.
Unknown Affiliation
Neuville, Mathilde
Unknown Affiliation
Oziel, Johanna
Unknown Affiliation
Papazian, Laurent
Unknown Affiliation
Souweine, Bertrand
Unknown Affiliation
Siami, Shidasp
Unknown Affiliation
Troché, Gilles
Unknown Affiliation
Thuong, Marie
Unknown Affiliation
Thierry, Guillaume L.
Unknown Affiliation
Yaacoubi, Sondes
Unknown Affiliation
Mellouk, Kaouttar Aid
Unknown Affiliation
Statistics
Citations: 10
Authors: 37
Affiliations: 8
Identifiers
Doi:
10.1186/s13054-019-2581-8
ISSN:
13648535
Research Areas
Environmental
Study Design
Cohort Study