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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study

Authors: Marc Garnier, Sacha Rozencwajg, Tài Pham, Sophie Vimont, Clarisse Blayau, Mehdi Hafiani, Jean-Pierre Fulgencio, Francis Bonnet, Jean-Luc Mainardi, Guillaume Arlet, Muriel Fartoukh, Salah Gallah, Christophe Quesnel

Published in: Critical Care | Issue 1/2017

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Abstract

Background

Rapid diagnostic tests detecting microbial resistance are needed for limiting the duration of inappropriateness of empirical antimicrobial therapy (EAT) in intensive care unit patients, besides reducing the use of broad-spectrum antibiotics. We hypothesized that the betaLACTA® test (BLT) could lead to early increase in the adequacy of antimicrobial therapy.

Methods

This was a case-control study. Sixty-one patients with BLT-guided adaptation of EAT were prospectively included, and then matched with 61 “controls” having similar infection characteristics (community or hospital-acquired, and source of infection), in whom EAT was conventionally adapted to antibiogram results. Endpoints were to compare the proportion of appropriate (primary endpoint) and optimal (secondary endpoint) antimicrobial therapies with each of the two strategies, once microbiological sample culture results were available.

Results

Characteristics of patients, infections and EAT at inclusion were similar between groups. Nine early escalations of EAT occurred in the BLT-guided adaptation group, reaching 98% appropriateness vs. 77% in the conventional adaptation group (p < 0.01). The BLT reduced the time until escalation of an inappropriate EAT from 50.5 (48–73) to 27 (24–28) hours (p < 0.01). Seventeen early de-escalations occurred in the BLT-guided adaptation group, compared to one in the conventional adaptation group, reducing patients’ exposure to broad-spectrum beta-lactam such as carbapenems. In multivariate analysis, use of the BLT was strongly associated with early appropriate (OR = 18 (3.4–333.8), p = 0.006) and optimal (OR = 35.5 (9.6–231.9), p < 0.001) antimicrobial therapies. Safety parameters were similar between groups.

Conclusions

Our study suggests that a BLT-guided adaptation strategy may allow early beta-lactam adaptation from the first 24 hours following the beginning of sepsis management.
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Metadata
Title
Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study
Authors
Marc Garnier
Sacha Rozencwajg
Tài Pham
Sophie Vimont
Clarisse Blayau
Mehdi Hafiani
Jean-Pierre Fulgencio
Francis Bonnet
Jean-Luc Mainardi
Guillaume Arlet
Muriel Fartoukh
Salah Gallah
Christophe Quesnel
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1746-6

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