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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Clinical outcome of wild-type AmpC-producing Enterobacterales infection in critically ill patients treated with β-lactams: a prospective multicenter study
Annals of Intensive Care, Volume 12, No. 1, Article 107, Year 2022
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Description
Background: β-lactams are the main antibiotics used against wild-type AmpC-producing Enterobacterales (wtAE). However, they may fail or select AmpC-overproducing mutants. Our aim was to assess factors associated with clinical failure of β-lactams in the treatment of wtAE infection. Methods: From September 2017 to December 2020, we prospectively included all consecutive patients treated by definitive β-lactams therapy for wtAE infection in four university ICUs. Clinical failure was defined as inadequate response to antimicrobial therapy leading to death or to the switch for a broader-spectrum antibiotic. Results: 177 patients were included and 29.4% progressed to clinical failure. E. cloacae was the most prevalent species (42.4%) and ventilator-associated pneumonia (VAP) was the most frequent wtAE infection (69.5%). Cefepime and cefotaxime were used as definitive antibiotic treatment in 42.9% and 27.7% of patients, respectively. Occurrence of AmpC-overproduction was documented in 5.6% of patients and was associated with clinical failure (p = 0.004). In multivariate analysis, VAP (p < 0.001, OR 11.58 [95% CI 3.11–43.02] and K. aerogenes (p = 0.030, OR 3.76 [95% CI 1.13–12.46]) were independently associated with clinical failure. Conversely, cefotaxime as definitive treatment was found inversely associated with the risk of clinical failure (p = 0.022, OR 0.25 [95% CI 0.08–0.82]). After inverse probability weighting, cefotaxime showed a 20% risk reduction of clinical failure (95% CI 5–35%, p = 0.007) whatever the location of infection, the SOFA score on the day of wtAE infection, or the bacterial species. Conclusions: Clinical failure in the treatment of wtAE infections is associated with the infection site and the causal microorganism. Additionally, cefotaxime use is probably protective against clinical failure in wtAE infection. © 2022, The Author(s).
Authors & Co-Authors
Mounier, Roman
France, Paris
Université Paris Cité
France, Creteil
Institut Mondor de Recherche Biomédicale
Woerther, Paul Louis
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Nacher, Mathieu
France, Paris
Inserm
Wolff, Michel A.
France, Paris
Université Paris Cité
Mekontso-Dessap, Armand
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Cook, Fabrice
Unknown Affiliation
Razazi, Keyvan
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Kallel, Hatem
France, Paris
Inserm
Statistics
Citations: 2
Authors: 8
Affiliations: 7
Identifiers
Doi:
10.1186/s13613-022-01079-5
ISSN:
21105820
Study Design
Cohort Study