Clinical outcome of wild-type AmpC-producing Enterobacterales infection in critically ill patients treated with β-lactams: a prospective multicenter study - Université Paris-Est-Créteil-Val-de-Marne Access content directly
Journal Articles Annals of Intensive Care Year : 2022

Clinical outcome of wild-type AmpC-producing Enterobacterales infection in critically ill patients treated with β-lactams: a prospective multicenter study

Roman Mounier
Ronan Le Guen
  • Function : Author
Mathieu Nacher
  • Function : Author
Clément Bonnefon
  • Function : Author
Nicolas Mongardon
Olivier Langeron
  • Function : Author
Eric Levesque
  • Function : Author
Séverine Couffin
  • Function : Author
Stéphanie Houcke
  • Function : Author
Michel Wolff
  • Function : Author
Ariane Roujansky
  • Function : Author
Caroline Schimpf
  • Function : Author
Armand Mekontso Dessap
Fabrice Cook
  • Function : Author
Keyvan Razazi
  • Function : Author
Hatem Kallel
  • Function : Author

Abstract

Abstract Background β-lactams are the main antibiotics used against wild-type AmpC-producing Enterobacterales (wtAE). However, they may fail or select AmpC-overproducing mutants. Our aim was to assess factors associated with clinical failure of β-lactams in the treatment of wtAE infection. Methods From September 2017 to December 2020, we prospectively included all consecutive patients treated by definitive β-lactams therapy for wtAE infection in four university ICUs. Clinical failure was defined as inadequate response to antimicrobial therapy leading to death or to the switch for a broader-spectrum antibiotic. Results 177 patients were included and 29.4% progressed to clinical failure. E. cloacae was the most prevalent species (42.4%) and ventilator-associated pneumonia (VAP) was the most frequent wtAE infection (69.5%). Cefepime and cefotaxime were used as definitive antibiotic treatment in 42.9% and 27.7% of patients, respectively. Occurrence of AmpC-overproduction was documented in 5.6% of patients and was associated with clinical failure ( p = 0.004). In multivariate analysis, VAP ( p < 0.001, OR 11.58 [95% CI 3.11–43.02] and K. aerogenes ( p = 0.030, OR 3.76 [95% CI 1.13–12.46]) were independently associated with clinical failure. Conversely, cefotaxime as definitive treatment was found inversely associated with the risk of clinical failure ( p = 0.022, OR 0.25 [95% CI 0.08–0.82]). After inverse probability weighting, cefotaxime showed a 20% risk reduction of clinical failure (95% CI 5–35%, p = 0.007) whatever the location of infection, the SOFA score on the day of wtAE infection, or the bacterial species. Conclusions Clinical failure in the treatment of wtAE infections is associated with the infection site and the causal microorganism. Additionally, cefotaxime use is probably protective against clinical failure in wtAE infection.

Dates and versions

hal-04298055 , version 1 (21-11-2023)

Identifiers

Cite

Roman Mounier, Ronan Le Guen, Paul-Louis Woerther, Mathieu Nacher, Clément Bonnefon, et al.. Clinical outcome of wild-type AmpC-producing Enterobacterales infection in critically ill patients treated with β-lactams: a prospective multicenter study. Annals of Intensive Care, 2022, 12 (1), pp.107. ⟨10.1186/s13613-022-01079-5⟩. ⟨hal-04298055⟩
4 View
0 Download

Altmetric

Share

Gmail Mastodon Facebook X LinkedIn More