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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae
Intensive Care Medicine, Volume 44, No. 5, Year 2018
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Description
Purpose: To investigate the clinical significance of infection-related ventilator-associated complications (IVAC) and their impact on carbapenem consumption in mechanically ventilated (MV) patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE). Methods: Inception cohort study from the French prospective multicenter OUTCOMEREA database (17 ICUs, 1997–2015) including all ESBLE carriers (systematic rectal swabbing at admission then weekly and/or urinary or superficial surgical site colonisation) with MV duration > 48 h and ≥ 1 episode of IVAC after carriage documentation. All ICU-acquired infections were microbiologically documented. Results: The 318 enrolled ESBLE carriers (median age 68 years; males 67%; medical admission 68%; imported carriage 53%) experienced a total of 576 IVAC comprising 361 episodes (63%) without documented infection, 124 (21%) related to infections other than ventilator-associated pneumonia (VAP), 73 (13%) related to non-ESBLE VAP and 18 (3%) related to ESBLE VAP. Overall, ESBLE infections accounted for only 43 episodes (7%). Carbapenem exposure within the preceding 3 days was the sole independent predictor of ESBLE infection as the causative event of IVAC, with a protective effect (adjusted odds ratio 0.2, 95% confidence interval 0.05–0.6; P < 0.01). Carbapenems were initiated in 9% of IVAC without infection, 15% of IVAC related to non-VAP infections, 42% of IVAC related to non-ESBLE VAP, and 56% of IVAC related to ESBLE VAP (ESBLE VAP versus non-ESBLE VAP: P = 0.43). Conclusions: IVAC in ESBLE carriers mostly reflect noninfectious events but act as a strong driver of empirical carbapenem consumption. ESBLE infections are scarce yet hard to predict, strengthening the need for novel diagnostic approaches and carbapenem-sparing alternatives. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.
Authors & Co-Authors
Barbier, François S.
France, Orleans
Chr D'orléans
Bailly, Sébastien D.Sign©bastien
France, Paris
Inserm
Schwebel, Carole
France, Grenoble
Centre Hospitalier Universitaire de Grenoble
Papazian, Laurent
France, Marseille
North Hospital
Azoulay, Elie
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Kallel, Hatem
Unknown Affiliation
Siami, Shidasp
Unknown Affiliation
Argaud, Laurent
France, Lyon
Hopital Edouard Herriot
Misset, Benoıˆt Y.
France, Rouen
Hopital Charles Nicolle
Darmon, Michaël
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Zahar, Jean Ralph
France, Bobigny
Hopital Avicenne
De Montmollin, E.
France, Saint-denis
Hôpital Delafontaine
Souweine, Bertrand
France, Clermont-ferrand
Hopital Gabriel Montpied
Mourvillier, Bruno H.
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Timsit, Jéan-François Franc¸ois
France, Paris
Inserm
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Statistics
Citations: 22
Authors: 15
Affiliations: 11
Identifiers
Doi:
10.1007/s00134-018-5154-4
ISSN:
03424642
Research Areas
Health System And Policy
Study Design
Cohort Study
Case-Control Study
Study Approach
Quantitative