Efficacy of carbapenem vs non carbapenem β-lactam therapy as empiric antimicrobial therapy in patients with extended-spectrum β-lactamase-producing Enterobacterales urinary septic shock: a propensity-weighted multicenter cohort study
Abstract Background The rise in antimicrobial resistance is a global threat responsible for about 33,000 deaths in 2015 with a particular concern for extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and has led to a major increase in the use of carbapenems, last-resort antibiotic...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-03-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-023-01106-z |
| _version_ | 1797859813675237376 |
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| author | Erwann Cariou Romain Griffier Arthur Orieux Stein Silva Stanislas Faguer Thierry Seguin Saad Nseir Emmanuel Canet Arnaud Desclaux Bertrand Souweine Kada Klouche Olivier Guisset Jerome Pillot Walter Picard Tahar Saghi Pierre Delobel Didier Gruson Renaud Prevel Alexandre Boyer |
| author_facet | Erwann Cariou Romain Griffier Arthur Orieux Stein Silva Stanislas Faguer Thierry Seguin Saad Nseir Emmanuel Canet Arnaud Desclaux Bertrand Souweine Kada Klouche Olivier Guisset Jerome Pillot Walter Picard Tahar Saghi Pierre Delobel Didier Gruson Renaud Prevel Alexandre Boyer |
| author_sort | Erwann Cariou |
| collection | DOAJ |
| description | Abstract Background The rise in antimicrobial resistance is a global threat responsible for about 33,000 deaths in 2015 with a particular concern for extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and has led to a major increase in the use of carbapenems, last-resort antibiotics. Methods In this retrospective propensity-weighted multicenter observational study conducted in 11 ICUs, the purpose was to assess the efficacy of non carbapenem regimen (piperacillin–tazobactam (PTZ) + aminoglycosides or 3rd-generation cephalosporin (3GC) + aminoglycosides) as empiric therapy in comparison with carbapenem in extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) urinary septic shock. The primary outcome was Day-30 mortality. Results Among 156 patients included in this study, 69 received a carbapenem and 87 received non carbapenem antibiotics as empiric treatment. Baseline clinical characteristics were similar between the two groups. Patients who received carbapenem had similar Day-30 mortality (10/69 (15%) vs 6/87 (7%), OR = 1.99 [0.55; 5.34] p = 0.16), illness severity, resolution of septic shock, and ESBL-E infection recurrence rates than patients who received an empiric non carbapenem therapy. The rates of secondary infection with C. difficile were comparable. Conclusions In ESBL-E urinary septic shock, empiric treatment with a non carbapenem regimen, including systematically aminoglycosides, was not associated with higher mortality, compared to a carbapenem regimen. |
| first_indexed | 2024-04-09T21:35:40Z |
| format | Article |
| id | doaj.art-49034ac7cbc543318b9b26456645737c |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-09T21:35:40Z |
| publishDate | 2023-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-49034ac7cbc543318b9b26456645737c2023-03-26T11:17:45ZengSpringerOpenAnnals of Intensive Care2110-58202023-03-0113111110.1186/s13613-023-01106-zEfficacy of carbapenem vs non carbapenem β-lactam therapy as empiric antimicrobial therapy in patients with extended-spectrum β-lactamase-producing Enterobacterales urinary septic shock: a propensity-weighted multicenter cohort studyErwann Cariou0Romain Griffier1Arthur Orieux2Stein Silva3Stanislas Faguer4Thierry Seguin5Saad Nseir6Emmanuel Canet7Arnaud Desclaux8Bertrand Souweine9Kada Klouche10Olivier Guisset11Jerome Pillot12Walter Picard13Tahar Saghi14Pierre Delobel15Didier Gruson16Renaud Prevel17Alexandre Boyer18Medical Intensive Care Unit, CHU de BordeauxDepartment of Public Health, University of BordeauxMedical Intensive Care Unit, CHU de BordeauxIntensive Care Unit, University Hospital of PurpanIntensive Care Unit, Department of Nephrology and Organ Transplantation, Centre for Rare Renal Diseases, University Hospital of ToulouseIntensive Care Unit, University Hospital of RangeuilDepartment of Intensive Care Medicine, Critical Care Center, CHU of LilleMedical Intensive Care Unit, Nantes University HospitalInfectious and Tropical Diseases Department, CHU BordeauxMedical Intensive Care Unit, Gabriel-Montpied University HospitalMedical Intensive Care Unit, CHU MontpellierMedical Intensive Care Unit, CHU de BordeauxIntensive Care Unit, Hôpital Saint-Léon, Centre Hospitalier de la Côte BasqueIntensive Care Unit, Centre Hospitalier de PauIntensive Care Unit, Polyclinique Bordeaux Nord AquitaineInfectious and Tropical Diseases Department, CHU ToulouseMedical Intensive Care Unit, CHU de BordeauxMedical Intensive Care Unit, CHU de BordeauxMedical Intensive Care Unit, CHU de BordeauxAbstract Background The rise in antimicrobial resistance is a global threat responsible for about 33,000 deaths in 2015 with a particular concern for extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and has led to a major increase in the use of carbapenems, last-resort antibiotics. Methods In this retrospective propensity-weighted multicenter observational study conducted in 11 ICUs, the purpose was to assess the efficacy of non carbapenem regimen (piperacillin–tazobactam (PTZ) + aminoglycosides or 3rd-generation cephalosporin (3GC) + aminoglycosides) as empiric therapy in comparison with carbapenem in extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) urinary septic shock. The primary outcome was Day-30 mortality. Results Among 156 patients included in this study, 69 received a carbapenem and 87 received non carbapenem antibiotics as empiric treatment. Baseline clinical characteristics were similar between the two groups. Patients who received carbapenem had similar Day-30 mortality (10/69 (15%) vs 6/87 (7%), OR = 1.99 [0.55; 5.34] p = 0.16), illness severity, resolution of septic shock, and ESBL-E infection recurrence rates than patients who received an empiric non carbapenem therapy. The rates of secondary infection with C. difficile were comparable. Conclusions In ESBL-E urinary septic shock, empiric treatment with a non carbapenem regimen, including systematically aminoglycosides, was not associated with higher mortality, compared to a carbapenem regimen.https://doi.org/10.1186/s13613-023-01106-zExtended-spectrum β-lactamase-producing EnterobacteralesNon carbapenem β-lactam therapyAntimicrobial resistanceSeptic shockUrinary tract infectionAminoglycosides |
| spellingShingle | Erwann Cariou Romain Griffier Arthur Orieux Stein Silva Stanislas Faguer Thierry Seguin Saad Nseir Emmanuel Canet Arnaud Desclaux Bertrand Souweine Kada Klouche Olivier Guisset Jerome Pillot Walter Picard Tahar Saghi Pierre Delobel Didier Gruson Renaud Prevel Alexandre Boyer Efficacy of carbapenem vs non carbapenem β-lactam therapy as empiric antimicrobial therapy in patients with extended-spectrum β-lactamase-producing Enterobacterales urinary septic shock: a propensity-weighted multicenter cohort study Annals of Intensive Care Extended-spectrum β-lactamase-producing Enterobacterales Non carbapenem β-lactam therapy Antimicrobial resistance Septic shock Urinary tract infection Aminoglycosides |
| title | Efficacy of carbapenem vs non carbapenem β-lactam therapy as empiric antimicrobial therapy in patients with extended-spectrum β-lactamase-producing Enterobacterales urinary septic shock: a propensity-weighted multicenter cohort study |
| title_full | Efficacy of carbapenem vs non carbapenem β-lactam therapy as empiric antimicrobial therapy in patients with extended-spectrum β-lactamase-producing Enterobacterales urinary septic shock: a propensity-weighted multicenter cohort study |
| title_fullStr | Efficacy of carbapenem vs non carbapenem β-lactam therapy as empiric antimicrobial therapy in patients with extended-spectrum β-lactamase-producing Enterobacterales urinary septic shock: a propensity-weighted multicenter cohort study |
| title_full_unstemmed | Efficacy of carbapenem vs non carbapenem β-lactam therapy as empiric antimicrobial therapy in patients with extended-spectrum β-lactamase-producing Enterobacterales urinary septic shock: a propensity-weighted multicenter cohort study |
| title_short | Efficacy of carbapenem vs non carbapenem β-lactam therapy as empiric antimicrobial therapy in patients with extended-spectrum β-lactamase-producing Enterobacterales urinary septic shock: a propensity-weighted multicenter cohort study |
| title_sort | efficacy of carbapenem vs non carbapenem β lactam therapy as empiric antimicrobial therapy in patients with extended spectrum β lactamase producing enterobacterales urinary septic shock a propensity weighted multicenter cohort study |
| topic | Extended-spectrum β-lactamase-producing Enterobacterales Non carbapenem β-lactam therapy Antimicrobial resistance Septic shock Urinary tract infection Aminoglycosides |
| url | https://doi.org/10.1186/s13613-023-01106-z |
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