Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) infections: are carbapenem alternatives achievable in daily practice?

Autor: B. Pilmis, T. Delory, M. Groh, E. Weiss, A. Emirian, H. Lecuyer, P. Lesprit, J.-R. Zahar
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Zdroj: International Journal of Infectious Diseases, Vol 39, Iss C, Pp 62-67 (2015)
Druh dokumentu: article
ISSN: 1201-9712
1878-3511
DOI: 10.1016/j.ijid.2015.08.011
Popis: Objectives: To avoid the use of carbapenems, alternatives such as cephamycin, piperacillin–tazobactam, and others are suggested for the treatment of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) infections. The aim of this study was to evaluate the frequency and the feasibility of antimicrobial de-escalation for ESBL-PE-related infections. Methods: A prospective observational, bi centric cohort study was conducted. All patients with ESBL-PE infections were included. De-escalation was systematically suggested if patients were clinically stable and the isolate was susceptible to possible alternatives. Results: Seventy-nine patients were included: 36 (45.6%) were children, 27 (34.1%) were hospitalized in intensive care units, and 37 (47%) were immunocompromised. Urinary tract infections, pneumonia, and catheter-related bloodstream infections accounted for 45.6%, 19%, and 10%, respectively, of the cohort. Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae were the three most frequent causative organisms isolated. On day 5, 47 (59.2%) of the patients were still receiving carbapenems. Antimicrobial resistance (44.7%), infection relapse (26.9%), and clinical instability (19.2%) were the most important reasons for not prescribing alternatives. E. coli-related infections appeared to be a protective factor against maintaining the carbapenem prescription (odds ratio 0.11, 95% confidence interval 0.041–0.324; p = 0.0013). Conclusions: In clinical practice, less than 50% of patients with ESBL-PE-related infections were de-escalated after empirical treatment with carbapenems.
Databáze: Directory of Open Access Journals
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