Impact of reduced antibiotic treatment duration on antimicrobial resistance in critically ill patients in the randomized controlled SAPS-trial.

Autor:	Shajiei A; Department of Critical Care, University Medical Center Groningen, Groningen, Netherlands.; Department of Medical Microbiology, University Medical Center Groningen, Groningen, Netherlands., Berends MS; Department of Medical Microbiology, University Medical Center Groningen, Groningen, Netherlands.; Department of Medical Epidemiology, Certe Foundation, Groningen, Netherlands., Luz CF; Department of Medical Microbiology, University Medical Center Groningen, Groningen, Netherlands., van Oers JA; Department of Intensive Care, Elisabeth-Tweesteden Ziekenhuis, Tilburg, Netherlands., Harmsen HJM; Department of Medical Microbiology, University Medical Center Groningen, Groningen, Netherlands., Vos P; Department of Intensive Care, Elisabeth-Tweesteden Ziekenhuis, Tilburg, Netherlands., Klont R; Laboratorium Microbiologie Twente Achterhoek, Hengelo, Netherlands., Loef BG; Department of Intensive Care, Martini Hospital Groningen, Groningen, Netherlands., Reidinga AC; Department of Intensive Care, Martini Hospital Groningen, Groningen, Netherlands., Bormans-Russell L; Department of Intensive Care, Zuyderland Medical Center, Heerlen, Netherlands., Linsen K; Department of Intensive Care, Zuyderland Medical Center, Heerlen, Netherlands., Dormans T; Department of Intensive Care, Zuyderland Medical Center, Heerlen, Netherlands., Otten M; Department of Intensive Care, Diakonessenhuis Utrecht, Utrecht, Netherlands., van der Bij A; Department of Microbiology and Immunology, Diakonessenhuis Utrecht, Utrecht, Netherlands., Beishuizen A; Intensive Care Center, Medisch Spectrum Twente, Enschede, Netherlands., de Lange DW; Department of Intensive Care, University Medical Center Utrecht, Utrecht, Netherlands., de Jong E; Department of Intensive Care, Beverwijk Hospital, Beverwijk, Netherlands.; Department of Intensive Care, Amsterdam University Medical Center, Amsterdam, Netherlands., Nijsten MW; Department of Critical Care, University Medical Center Groningen, Groningen, Netherlands.
Jazyk:	angličtina
Zdroj:	Frontiers in medicine [Front Med (Lausanne)] 2023 Feb 02; Vol. 10, pp. 1080007. Date of Electronic Publication: 2023 Feb 02 (Print Publication: 2023).
DOI:	10.3389/fmed.2023.1080007
Abstrakt:	Background: In the previously reported SAPS trial (https://clinicaltrials.gov/ct2/show/NCT01139489), procalcitonin-guidance safely reduced the duration of antibiotic treatment in critically ill patients. We assessed the impact of shorter antibiotic treatment on antimicrobial resistance development in SAPS patients. Materials and Methods: Cultures were assessed for the presence of multi-drug resistant (MDR) or highly resistant organisms (HRMO) and compared between PCT-guided and control patients. Baseline isolates from 30 days before to 5 days after randomization were compared with those from 5 to 30 days post-randomization. The primary endpoint was the incidence of new MDR/HRMO positive patients. Results: In total, 8,113 cultures with 96,515 antibiotic test results were evaluated for 439 and 482 patients randomized to the PCT and control groups, respectively. Disease severity at admission was similar for both groups. Median (IQR) durations of the first course of antibiotics were 6 days (4-10) and 7 days (5-11), respectively ( p = 0.0001). Antibiotic-free days were 7 days (IQR 0-14) and 6 days (0-13; p = 0.05). Of all isolates assessed, 13% were MDR/HRMO positive and at baseline 186 (20%) patients were MDR/HMRO-positive. The incidence of new MDR/HRMO was 39 (8.9%) and 45 (9.3%) in PCT and control patients, respectively ( p = 0.82). The time courses for MDR/HRMO development were also similar for both groups ( p = 0.33). Conclusions: In the 921 randomized patients studied, the small but statistically significant reduction in antibiotic treatment in the PCT-group did not translate into a detectable change in antimicrobial resistance. Studies with larger differences in antibiotic treatment duration, larger study populations or populations with higher MDR/HRMO incidences might detect such differences. Competing Interests: MB was employed by Certe Foundation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This study received funding from Thermo Fisher Scientific (Waltham, MA, USA). This funder had the following involvement with the study: During the SAPS-trial we received financial support for the database design and randomization and received PCT kits at reduced cost from Thermo Fisher. (Copyright © 2023 Shajiei, Berends, Luz, van Oers, Harmsen, Vos, Klont, Loef, Reidinga, Bormans-Russell, Linsen, Dormans, Otten, van der Bij, Beishuizen, de Lange, de Jong and Nijsten.)
Databáze:	MEDLINE
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