Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care—an analysis of the OUTCOMEREA database
Abstract Introduction Enterococcus species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subj...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-09-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-019-2581-8 |
| _version_ | 1818545165411811328 |
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| author | Anne-Cécile Morvan Baptiste Hengy Maïté Garrouste-Orgeas Stéphane Ruckly Jean-Marie Forel Laurent Argaud Thomas Rimmelé Jean-Pierre Bedos Elie Azoulay Claire Dupuis Bruno Mourvillier Carole Schwebel Jean-François Timsit On behalf of the OUTCOMEREA study group |
| author_facet | Anne-Cécile Morvan Baptiste Hengy Maïté Garrouste-Orgeas Stéphane Ruckly Jean-Marie Forel Laurent Argaud Thomas Rimmelé Jean-Pierre Bedos Elie Azoulay Claire Dupuis Bruno Mourvillier Carole Schwebel Jean-François Timsit On behalf of the OUTCOMEREA study group |
| author_sort | Anne-Cécile Morvan |
| collection | DOAJ |
| description | Abstract Introduction Enterococcus species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subjected to debate, except in septic shock. The aim of our study was to evaluate whether an IAT that did not cover Enterococcus spp. was associated with 30-day mortality in ICU patients presenting with IAI growing with Enterococcus spp. Material and methods Retrospective analysis of French database OutcomeRea from 1997 to 2016. We included all patients with IAI with a peritoneal sample growing with Enterococcus. Primary endpoint was 30-day mortality. Results Of the 1017 patients with IAI, 76 (8%) patients were included. Thirty-day mortality in patients with inadequate IAT against Enterococcus was higher (7/18 (39%) vs 10/58 (17%), p = 0.05); however, the incidence of postoperative complications was similar. Presence of Enterococcus spp. other than E. faecalis alone was associated with a significantly higher mortality, even greater when IAT was inadequate. Main risk factors for having an Enterococcus other than E. faecalis alone were as follows: SAPS score on day 0, ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI especially with third-generation cephalosporins. Univariate analysis found a higher hazard ratio of death with an Enterococcus other than E. faecalis alone that had an inadequate IAT (HR = 4.4 [1.3–15.3], p = 0.019) versus an adequate IAT (HR = 3.1 [1.0–10.0], p = 0.053). However, after adjusting for confounders (i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and adequacy of IAT for other germs), the impact of the adequacy of IAT was no longer significant in multivariate analysis. Septic shock at diagnosis and ICU-acquired IAI were prognostic factors. Conclusion An IAT which does not cover Enterococcus is associated with an increased 30-day mortality in ICU patients presenting with an IAI growing with Enterococcus, especially when it is not an E. faecalis alone. It seems reasonable to use an IAT active against Enterococcus in severe postoperative ICU-acquired IAI, especially when a third-generation cephalosporin has been used within 3 months. |
| first_indexed | 2024-12-11T22:57:57Z |
| format | Article |
| id | doaj.art-7df379c9a62d47399556ed437d78b052 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-11T22:57:57Z |
| publishDate | 2019-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-7df379c9a62d47399556ed437d78b0522022-12-22T00:47:09ZengBMCCritical Care1364-85352019-09-0123111010.1186/s13054-019-2581-8Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care—an analysis of the OUTCOMEREA databaseAnne-Cécile Morvan0Baptiste Hengy1Maïté Garrouste-Orgeas2Stéphane Ruckly3Jean-Marie Forel4Laurent Argaud5Thomas Rimmelé6Jean-Pierre Bedos7Elie Azoulay8Claire Dupuis9Bruno Mourvillier10Carole Schwebel11Jean-François Timsit12On behalf of the OUTCOMEREA study groupDepartment of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Teaching HospitalDepartment of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Teaching HospitalPolyvalent ICU, St Joseph HospitalUMR 1137 – IAME Team 5 – DeSCID: Decision Sciences in Infectious Diseases, Control and Care INSERM Paris Diderot University, Sorbonne Paris CitéMedical ICU, Respiratory Distress and Severe Infections, Nord Hospital, URMITE CNRS-UMR 6236, Aix-Marseille University, AP-HMMedical ICU, Hospices Civils de Lyon, Edouard Herriot Teaching HospitalDepartment of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Teaching HospitalIntensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles - Site André MignotMedical ICU, APHP, Saint-Louis Hospital, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne UniversityMedical and Infectious Diseases ICU, Bichat University Hospital, AP-HPMedical and Infectious Diseases ICU, Bichat University Hospital, AP-HPMedical ICU, Albert Michallon Hospital, Grenoble 1 UniversityMedical and Infectious Diseases ICU, Bichat University Hospital, AP-HPAbstract Introduction Enterococcus species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subjected to debate, except in septic shock. The aim of our study was to evaluate whether an IAT that did not cover Enterococcus spp. was associated with 30-day mortality in ICU patients presenting with IAI growing with Enterococcus spp. Material and methods Retrospective analysis of French database OutcomeRea from 1997 to 2016. We included all patients with IAI with a peritoneal sample growing with Enterococcus. Primary endpoint was 30-day mortality. Results Of the 1017 patients with IAI, 76 (8%) patients were included. Thirty-day mortality in patients with inadequate IAT against Enterococcus was higher (7/18 (39%) vs 10/58 (17%), p = 0.05); however, the incidence of postoperative complications was similar. Presence of Enterococcus spp. other than E. faecalis alone was associated with a significantly higher mortality, even greater when IAT was inadequate. Main risk factors for having an Enterococcus other than E. faecalis alone were as follows: SAPS score on day 0, ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI especially with third-generation cephalosporins. Univariate analysis found a higher hazard ratio of death with an Enterococcus other than E. faecalis alone that had an inadequate IAT (HR = 4.4 [1.3–15.3], p = 0.019) versus an adequate IAT (HR = 3.1 [1.0–10.0], p = 0.053). However, after adjusting for confounders (i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and adequacy of IAT for other germs), the impact of the adequacy of IAT was no longer significant in multivariate analysis. Septic shock at diagnosis and ICU-acquired IAI were prognostic factors. Conclusion An IAT which does not cover Enterococcus is associated with an increased 30-day mortality in ICU patients presenting with an IAI growing with Enterococcus, especially when it is not an E. faecalis alone. It seems reasonable to use an IAT active against Enterococcus in severe postoperative ICU-acquired IAI, especially when a third-generation cephalosporin has been used within 3 months.http://link.springer.com/article/10.1186/s13054-019-2581-8Intensive careIntraabdominal infectionsMortalityEnterococcus spp.Antibiotic therapy |
| spellingShingle | Anne-Cécile Morvan Baptiste Hengy Maïté Garrouste-Orgeas Stéphane Ruckly Jean-Marie Forel Laurent Argaud Thomas Rimmelé Jean-Pierre Bedos Elie Azoulay Claire Dupuis Bruno Mourvillier Carole Schwebel Jean-François Timsit On behalf of the OUTCOMEREA study group Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care—an analysis of the OUTCOMEREA database Critical Care Intensive care Intraabdominal infections Mortality Enterococcus spp. Antibiotic therapy |
| title | Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care—an analysis of the OUTCOMEREA database |
| title_full | Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care—an analysis of the OUTCOMEREA database |
| title_fullStr | Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care—an analysis of the OUTCOMEREA database |
| title_full_unstemmed | Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care—an analysis of the OUTCOMEREA database |
| title_short | Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care—an analysis of the OUTCOMEREA database |
| title_sort | impact of species and antibiotic therapy of enterococcal peritonitis on 30 day mortality in critical care an analysis of the outcomerea database |
| topic | Intensive care Intraabdominal infections Mortality Enterococcus spp. Antibiotic therapy |
| url | http://link.springer.com/article/10.1186/s13054-019-2581-8 |
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