Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 31;11(11):2676.
doi: 10.3390/microorganisms11112676.

Antibiotic Prescriptions in Critically Ill Patients with Bloodstream Infection Due to ESBL-Producing Enterobacteriaceae: Compliance with the French Guidelines for the Treatment of Infections with Third-Generation Cephalosporin-Resistant Enterobacteriaceae-A Multicentric Retrospective Cohort Study

Camille Le Berre  1 , Marion Houard  2 , Anne Vachée  3 , Hugues Georges  1 , Frederic Wallet  4 , Pierre Patoz  5 , Patrick Herbecq  6 , Saad Nseir  2 , Pierre-Yves Delannoy  1 , Agnès Meybeck  1
Affiliations

Antibiotic Prescriptions in Critically Ill Patients with Bloodstream Infection Due to ESBL-Producing Enterobacteriaceae: Compliance with the French Guidelines for the Treatment of Infections with Third-Generation Cephalosporin-Resistant Enterobacteriaceae-A Multicentric Retrospective Cohort Study

Camille Le Berre et al. Microorganisms. .

Abstract

National and international guidelines were recently published regarding the treatment of Enterobacteriaceae resistant to third-generation cephalosporins infections. We aimed to assess the implementation of the French guidelines in critically ill patients suffering from extended-spectrum β-lactamase-producing Enterobacteriaceae bloodstream infection (ESBL-E BSI). We conducted a retrospective observational cohort study in the ICU of three French hospitals. Patients treated between 2018 and 2022 for ESBL-E BSI were included. The primary assessment criterion was the proportion of adequate empirical carbapenem prescriptions, defined as prescriptions consistent with the French guidelines. Among the 185 included patients, 175 received an empirical anti-biotherapy within 24 h of ESBL-E BSI onset, with a carbapenem for 100 of them. The proportion of carbapenem prescriptions consistent with the guidelines was 81%. Inconsistent prescriptions were due to a lack of prescriptions of a carbapenem, while it was recommended in 25% of cases. The only factor independently associated with adequate empirical carbapenem prescription was ESBL-E colonization (OR: 107.921 [9.303-1251.910], p = 0.0002). The initial empirical anti-biotherapy was found to be appropriate in 83/98 patients (85%) receiving anti-biotherapy in line with the guidelines and in 56/77 (73%) patients receiving inadequate anti-biotherapy (p = 0.06). Our results illustrate the willingness of intensivists to spare carbapenems. Promoting implementation of the guidelines could improve the proportion of initial appropriate anti-biotherapy in critically ill patients with ESBL-E BSI.

Keywords: antibiotics; bacteremia; carbapenem sparing; critical care; extended-spectrum beta-lactamase-producing Enterobacteriaceae; guidelines.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Empirical and definitive antibiotic prescriptions in patients treated for ESBL-E BSI in the ICU.
Figure 2
Figure 2
The proportion of empirical carbapenem prescriptions concordant with the French guidelines.
See this image and copyright information in PMC

References

    1. Rodríguez-Baño J., Navarro M.D., Romero L., Muniain M.A., de Cueto M., Ríos M.J., Hernandez J.R., Pascual A. Bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli in the CTX-M era: A new clinical challenge. Clin. Infect. Dis. 2006;43:1407–1414. doi: 10.1086/508877. - DOI - PubMed
    1. Tumbarello M., Sanguinetti M., Montuori E., Trecarichi E.M., Posteraro B., Fiori B., Citton R., D’Inzeo T., Fadda G., Cauda R., et al. Predictors of mortality in patients with bloodstream infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: Importance of inadequate initial antimicrobial treatment. Antimicrob. Agents Chemother. 2007;51:1987–1994. doi: 10.1128/AAC.01509-06. - DOI - PMC - PubMed
    1. Jean S.S., Harnod D., Hsueh P.R. Global threat of carbapenem-resistant Gram-negative bacteria. Front. Cell. Infect. Microbiol. 2022;12:823684. doi: 10.3389/fcimb.2022.823684. - DOI - PMC - PubMed
    1. Tamma P.D., Rodriguez J. The use of noncarbapenem β-lactams for the treatment of extended-spectrum β-lactamase infections. Clin. Infect. Dis. 2017;2017:972–980. doi: 10.1093/cid/cix034. - DOI - PMC - PubMed
    1. Harris P.N.A., Tambyah P.A., Lye D.C., Mo Y., Lee T.H., Yilmaz M., Alenazi T.H., Arabi Y., Falcone M., Bassetti M., et al. MERINO Trial Investigators and the Australasian Society for Infectious Disease Clinical ResearchNetwork (ASID-CRN). Effect of piperacillin-tazobactam vs meropenem on 30-Day mortality for patients with E. coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance: A randomized clinical trial. JAMA. 2018;320:984–994. - PMC - PubMed

LinkOut - more resources