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01-05-2018 | Original

Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae

Authors: François Barbier, Sébastien Bailly, Carole Schwebel, Laurent Papazian, Élie Azoulay, Hatem Kallel, Shidasp Siami, Laurent Argaud, Guillaume Marcotte, Benoît Misset, Jean Reignier, Michaël Darmon, Jean-Ralph Zahar, Dany Goldgran-Toledano, Étienne de Montmollin, Bertrand Souweine, Bruno Mourvillier, Jean-François Timsit, for the OUTCOMEREA Study Group

Published in: Intensive Care Medicine | Issue 5/2018

Abstract

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.

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Title: Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae
Authors: François Barbier
Sébastien Bailly
Carole Schwebel
Laurent Papazian
Élie Azoulay
Hatem Kallel
Shidasp Siami
Laurent Argaud
Guillaume Marcotte
Benoît Misset
Jean Reignier
Michaël Darmon
Jean-Ralph Zahar
Dany Goldgran-Toledano
Étienne de Montmollin
Bertrand Souweine
Bruno Mourvillier
Jean-François Timsit
for the OUTCOMEREA Study Group
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 5/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5154-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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