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. 2025 Mar 20;15(1):34.
doi: 10.1186/s13613-025-01456-w.

Relative faecal abundance to predict extended-spectrum β-lactamase-producing Enterobacterales related ventilator‑associated pneumonia

Pierre Bay  1   2   3 , Paul-Louis Woerther  4   5 , Vincent Fihman  4 , Ségolène Gendreau  6   7 , Pascale Labedade  6   7 , Antoine Gaillet  6   7 , Florian Jolly  6   7 , Guillaume Carteaux  6   7 , Nicolas de Prost  6   7   8 , Jean-Winoc Decousser  4   5 , Armand Mekontso-Dessap  6   7 , Keyvan Razazi  6   7
Affiliations

Relative faecal abundance to predict extended-spectrum β-lactamase-producing Enterobacterales related ventilator‑associated pneumonia

Pierre Bay et al. Ann Intensive Care. .

Abstract

Background: Antimicrobial stewardship (AMS) for ventilator-associated pneumonia (VAP) in carriers of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) presents significant challenges. The abundance of ESBL-E rectal carriage has emerged as a potentially valuable tool for predicting ESBL-E-related VAP.

Methods: This single-center, retrospective study was conducted between October 2019 and April 2023 in the medical ICU of a university hospital. The relative abundance of ESBL-E rectal carriage (RAC) was calculated as the ratio of ESBL-E counts to the total number of aerotolerant bacteria. The aim was to evaluate the predictive value of RAC for diagnosing ESBL-E-related VAP in patients with confirmed VAP who were ESBL-E carriers.

Results: During the study period, 478 patients with ESBL-E carriage were admitted to the ICU, of whom 231 (48%) required mechanical ventilation. Eighty-three patients (17%) developed a total of 131 confirmed VAP episodes, of which 62 episodes (47%) were ESBL-E-related VAP. The median interval between the last rectal screening and VAP occurrence was 4 [3-7] days. RAC was not associated with ESBL-E-related VAP in the entire cohort (p = 0.39). Similar findings were observed in several sensitivity analyses, including the following subsets: recent and high-quality screening (interval between screening and VAP ≤ 7 days and bacterial load on rectal swab > 104 CFU/mL, p = 0.21); first VAP episodes only (p = 0.41); cases involving Escherichia coli exclusively (p = 0.08) or other ESBL-E strains (p = 0.29); and VAP associated with Gram-negative bacteria (p = 0.26) or Enterobacterales (p = 0.34). However, in a multivariable model, rectal colonization with non-Escherichia coli ESBL strains was independently associated with ESBL-E-related VAP (adjusted odds ratio [aOR] 1.213 [95% CI 1.005-1.463], p = 0.045).

Conclusion: RAC was not associated with confirmed VAP in ESBL-E carriers. Further studies are needed to explore effective strategies for improving AMS in ESBL-E carriers with suspected VAP.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This observational study was approved by the Ethics Committee of the French Intensive Care Society (CE SRLF 24-009, IRB N°00014135). Patients were informed of their inclusion in the study and written consent was waived in accordance with French law. The database is registered with the “Commission Nationale de l’Informatique et des Libertés” (n°2232944). Consent for publication: Not applicable. Competing interests: GC reports personal fees from Air Liquide Medical System, GE Healthcare, Dräger, Fisher and Paykel, Medtronic and Löwenstein, outside the submitted work. AMD reports grants from Fischer Paykel, Baxter, Philips, Ferring and GSK, personal fees from Air Liquide, Baxter, Amomed, Getingue and Addmedica, outside the submitted work. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Relative abundance of ESBL-E rectal assessment. A Automated seeding of rectal swabs using WASP® instrument (PREVI Isola, bioMérieux, France) on chromogenic agar (Oxoid Ltd, Cambridge, UK; Biomérieux, Courtaboeuf, France) for ESBL-E semi-quantification assessment and on Tryptic soy agar for aerotolerant bacterial. B Semi-quantitative counting of bacteria after incubation
Fig. 2
Fig. 2
Flow chart of the 131 confirmed VAP episodes in mechanically ventilated ESBL-E carriers. ESBL-E: extended-spectrum β-lactamase-producing Enterobacterales; MV: mechanical ventilation; VAP: ventilator associated pneumonia
Fig. 3
Fig. 3
Relative abundance of ESBL-E rectal carriage (RAC) according to ESBL-E related VAP status. A RAC distribution according to ESBL-E colonisation (Escherichia coli only vs. other ESBL-E). B RAC according to ESBL-E related VAP status of the 131 confirmed ventilator-associated pneumonia. C RAC according to ESBL-E related VAP status of the 65 confirmed ventilator-associated pneumonia in Escherichia coli carriers. D RAC according to ESBL-E related VAP status of the 66 confirmed ventilator-associated pneumonia in non Escherichia coli carriers. ESBL-E: extended-spectrum β-lactamase-producing Enterobacterales; RAC: relative abundance of ESBL-E rectal carriage; VAP: ventilator-associated pneumonia. P-values come from unadjusted comparisons using Cochran–armitage trend test
See this image and copyright information in PMC

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