Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study
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® te...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-06-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-017-1746-6 |
| _version_ | 1818159837927702528 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Marc Garnier |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T15:52:20Z |
| format | Article |
| id | doaj.art-82f195e8394c4bf3a7ed74a31fbe57a2 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-11T15:52:20Z |
| publishDate | 2017-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-82f195e8394c4bf3a7ed74a31fbe57a22022-12-22T00:59:33ZengBMCCritical Care1364-85352017-06-0121111010.1186/s13054-017-1746-6Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control studyMarc Garnier0Sacha Rozencwajg1Tài Pham2Sophie Vimont3Clarisse Blayau4Mehdi Hafiani5Jean-Pierre Fulgencio6Francis Bonnet7Jean-Luc Mainardi8Guillaume Arlet9Muriel Fartoukh10Salah Gallah11Christophe Quesnel12Département d’Anesthésie et Réanimation, APHP Hôpital TenonDépartement d’Anesthésie et Réanimation, APHP Hôpital TenonAPHP Hôpital Tenon, Unité de Réanimation Médico-ChirurgicaleUniversité Pierre et Marie Curie Sorbonne UniversitéDépartement d’Anesthésie et Réanimation, APHP Hôpital TenonDépartement d’Anesthésie et Réanimation, APHP Hôpital TenonDépartement d’Anesthésie et Réanimation, APHP Hôpital TenonDépartement d’Anesthésie et Réanimation, APHP Hôpital TenonAPHP Hôpital Européen Georges Pompidou, Service de MicrobiologieUniversité Pierre et Marie Curie Sorbonne UniversitéAPHP Hôpital Tenon, Unité de Réanimation Médico-ChirurgicaleDépartement de Bactériologie, APHP Hôpitaux Universitaires Est Parisiens - site TenonDépartement d’Anesthésie et Réanimation, APHP Hôpital TenonAbstract 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.http://link.springer.com/article/10.1186/s13054-017-1746-6Antimicrobial agent administrationMicrobial susceptibility testsBeta-lactam resistanceExtended-spectrum beta-lactamaseIntensive care unit |
| spellingShingle | 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 Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study Critical Care Antimicrobial agent administration Microbial susceptibility tests Beta-lactam resistance Extended-spectrum beta-lactamase Intensive care unit |
| title | Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study |
| title_full | Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study |
| title_fullStr | Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study |
| title_full_unstemmed | Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study |
| title_short | Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study |
| title_sort | evaluation of early antimicrobial therapy adaptation guided by the betalacta r test a case control study |
| topic | Antimicrobial agent administration Microbial susceptibility tests Beta-lactam resistance Extended-spectrum beta-lactamase Intensive care unit |
| url | http://link.springer.com/article/10.1186/s13054-017-1746-6 |
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