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. 2018 May;44(5):616-626.
doi: 10.1007/s00134-018-5154-4. Epub 2018 Apr 16.

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

François Barbier  1 , Sébastien Bailly  2 , Carole Schwebel  3 , Laurent Papazian  4 , Élie Azoulay  5 , Hatem Kallel  6 , Shidasp Siami  7 , Laurent Argaud  8 , Guillaume Marcotte  9 , Benoît Misset  10 , Jean Reignier  11 , Michaël Darmon  5 , Jean-Ralph Zahar  12 , Dany Goldgran-Toledano  13 , Étienne de Montmollin  14 , Bertrand Souweine  15 , Bruno Mourvillier  16 , Jean-François Timsit  17   18 ; OUTCOMEREA Study Group
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Free article

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

François Barbier et al. Intensive Care Med. 2018 May.
Free article

Erratum in

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.

Keywords: Carbapenem; Extended-spectrum beta-lactamase; Mechanical ventilation; Outcome; Ventilator-associated pneumonia.

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