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Antibiotic definitive treatment in ventilator associated pneumonia caused by AmpC-producing Enterobacterales in critically ill patients: a prospective multicenter observational study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年2月5日

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  • Matthieu Petit,
  • Frank Bidar,
  • Quentin Fosse,
  • Lucie Lefevre,
  • Marine Paul,
  • Tomas Urbina,
  • Paul Masi,
  • Florent Bavozet,
  • Jérémie Lemarié,
  • Etienne de Montmollin,
  • Chloé Andriamifidy-Berti,
  • Julien Dessajan,
  • Benjamin Zuber,
  • Lara Zafrani,
  • Edwige Peju,
  • Paris Meng,
  • Liliane Charrier,
  • Loic Le Guennec,
  • Marie Simon,
  • Charles-Edouard Luyt,
  • Luc Haudebourg,
  • Guillaume Geri

摘要

Background

Ventilator associated pneumonia (VAP) due to wild-type AmpC-producing Enterobacterales (wtAE) is frequent in intensive care unit (ICU) patients. Despite a low level of evidence, definitive antimicrobial therapy (AMT) with third generation cephalosporins (3GCs) or piperacillin is discouraged.

Methods

Observational prospective study including consecutive wtAE VAP patients in 20 French ICUs. The primary objective was to assess the association of the choice of definitive AMT, i.e. piperacillin ± tazobactam (PTZ), 3GCs or other molecule (4GCs, carbapenems, quinolones, cotrimoxazole; control group), with treatment success at day-7. Recurrence of infection was collected as a secondary outcome, and analyzed accounting for the competing risk of death.

Results

From February 2021 to June 2022, 274 patients were included. Enterobacter cloacae was the most prevalent specie (31%). Seventy-eight patients (28%) had PTZ as definitive AMT while 44 (16%) had 3GCs and 152 (56%) were classified in the control group. Day-7 success rate was similar between the 3 groups (74% vs. 73% vs. 68% respectively, p = 0.814). Recurrence probability at day-28 was 31% (95% CI 21–42), 40% (95% CI 26–55) and 21% (95% CI 15–28) for PTZ, 3GCs and control groups (p = 0.020). In multivariable analysis, choice of definitive AMT was not associated with clinical success, but definitive AMT with 3GCs was associated with recurrence at day-28 [csHR(95%CI) 10.9 (1.92–61.91)].

Conclusion

Choice of definitive antimicrobial therapy was not associated with treatment success at day 7. However, recurrence of pneumonia at day-28 was higher in patients treated with third generation cephalosporins with no differences in mortality or mechanical ventilation duration.