Gram-negative bacteremia: Which empirical antibiotic therapy?
Given the increasing frequency of cefotaxime-resistant strains, third-generation cephalosporins (3GC e.g. cefotaxime, ceftriaxone) might not be recommended any longer as empirical antibiotic therapy for community-acquired Gram-negative bacteremia (CA-GNB). We conducted a multicenter prospective desc...
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| Veröffentlicht in: | Médecine et maladies infectieuses 2014-04, Vol.44 (4), p.159-166 |
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| creator | Shoai Tehrani, M. Hajage, D. Fihman, V. Tankovic, J. Cau, S. Day, N. Visseaux, C. Carbonnelle, E. Kouatchet, A. Cattoir, V. Nhan, T.X. Corvec, S. Jacquier, H. Jauréguy, F. Le Monnier, A. Morand, P. Zahar, J.R. |
| description | Given the increasing frequency of cefotaxime-resistant strains, third-generation cephalosporins (3GC e.g. cefotaxime, ceftriaxone) might not be recommended any longer as empirical antibiotic therapy for community-acquired Gram-negative bacteremia (CA-GNB).
We conducted a multicenter prospective descriptive study including patients with CA-GNB.
Two hundred and nineteen patients were included. Escherichia coli and Pseudomonas aeruginosa were the most frequently isolated species in 63% (n=138) and 11% (n=24) of the cases, respectively. The prevalence of cefotaxime-resistance reached 18% (n=39) mostly due to intrinsic resistance (27 cases, 12%). The presence of invasive material (P |
| doi_str_mv | 10.1016/j.medmal.2014.01.013 |
| format | Article |
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We conducted a multicenter prospective descriptive study including patients with CA-GNB.
Two hundred and nineteen patients were included. Escherichia coli and Pseudomonas aeruginosa were the most frequently isolated species in 63% (n=138) and 11% (n=24) of the cases, respectively. The prevalence of cefotaxime-resistance reached 18% (n=39) mostly due to intrinsic resistance (27 cases, 12%). The presence of invasive material (P<0.001), the origin of the patient (Paris region or West of France) (P=0.006), and home health care (P<0.001) were variables predicting resistant GNB. The negative predictive value for resistance in patients with invasive material coming from the West of France, or without invasive material and with home health care was 94%. The positive predictive value for patients with invasive material living in Paris, or without invasive material and with home health care only reached 58 and 54%, respectively.
Using 3GC for CA-GNB due to cefotaxime-resistant strains was relatively frequent, ESBL-producing Enterobacteriaceae being rarely involved. Our study highlights the role of local epidemiology; before any changes to first-line antibiotic therapy, local epidemiological data should be taken into account.
La diffusion des bacilles à gram négatif résistant aux antibiotiques en communautaire nous questionne sur le choix probabiliste recommandé des céphalosporines de 3e génération (C3G, i.e. céfotaxime, ceftriaxone) dans les bactériémies communautaires à bacille à Gram négatif (BGN).
Nous avons conduit une étude descriptive prospective multicentrique, incluant les patients admis pour une bactériémie à BGN.
Parmi les 219 patients inclus, les espèces les plus fréquemment isolées étaient Escherichia coli et Pseudomonas aeruginosa dans respectivement 63 (n=138) et 11 % (n=24) des cas. La prévalence des souches résistantes au céfotaxime était de 18 % (n=39), L’existence de matériel invasif (p<0,001), l’origine géographique du patient (Île-de-France [IDF] comparativement à l’ouest de la France) (p=0,006), et les soins à domicile (p<0,001) étaient les variables prédictives d’une bactériémie à BGN résistant. L’association de l’origine géographique du patient (Ouest de la France) à la présence de matériel, ou de l’absence de matériel avec des soins à domicile, avait une valeur prédictive négative de 94 %. La valeur prédictive positive, chez les patients porteurs de matériel et résidant en IDF ou sans matériel et recevant des soins à domicile, n’était que de 58 et 54 %, respectivement.
L’utilisation de C3G en cas de bactériémie à BGN communautaire était relativement fréquente, les entérobactéries produisant des BLSE étant rarement impliquées. L’épidémiologie locale de la résistance est un élément incontournable à prendre en compte avant toute modification de l’antibiothérapie probabiliste.</description><identifier>ISSN: 0399-077X</identifier><identifier>EISSN: 1769-6690</identifier><identifier>DOI: 10.1016/j.medmal.2014.01.013</identifier><identifier>PMID: 24661557</identifier><identifier>CODEN: MMAIB5</identifier><language>eng</language><publisher>Paris: Elsevier SAS</publisher><subject>Aged ; Anti-Bacterial Agents - therapeutic use ; Antibacterial agents ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Bacteremia - drug therapy ; Bacterial diseases ; Bacterial sepsis ; Bactériémie à Gram négatif ; Biological and medical sciences ; Bêta-lactamase à spectre étendu ; Cefotaxime-resistance ; Cephalosporin Resistance ; Community-Acquired Infections - drug therapy ; Enterobacteriaceae ; Escherichia coli ; Extended-spectrum b-lactamase ; Gram-negative bacteremia ; Gram-Negative Bacterial Infections - drug therapy ; Health care-associated infection ; Human bacterial diseases ; Humans ; Infectious diseases ; Medical sciences ; Pharmacology. Drug treatments ; Prospective Studies ; Pseudomonas aeruginosa ; Résistance au céfotaxime</subject><ispartof>Médecine et maladies infectieuses, 2014-04, Vol.44 (4), p.159-166</ispartof><rights>2014 Elsevier Masson SAS</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 Elsevier Masson SAS. All rights reserved.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c471t-26a9f25fb21bc40d3e249b182024708b602c533c7866b6add9f9c3e0403c56bf3</citedby><cites>FETCH-LOGICAL-c471t-26a9f25fb21bc40d3e249b182024708b602c533c7866b6add9f9c3e0403c56bf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.medmal.2014.01.013$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28423960$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24661557$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shoai Tehrani, M.</creatorcontrib><creatorcontrib>Hajage, D.</creatorcontrib><creatorcontrib>Fihman, V.</creatorcontrib><creatorcontrib>Tankovic, J.</creatorcontrib><creatorcontrib>Cau, S.</creatorcontrib><creatorcontrib>Day, N.</creatorcontrib><creatorcontrib>Visseaux, C.</creatorcontrib><creatorcontrib>Carbonnelle, E.</creatorcontrib><creatorcontrib>Kouatchet, A.</creatorcontrib><creatorcontrib>Cattoir, V.</creatorcontrib><creatorcontrib>Nhan, T.X.</creatorcontrib><creatorcontrib>Corvec, S.</creatorcontrib><creatorcontrib>Jacquier, H.</creatorcontrib><creatorcontrib>Jauréguy, F.</creatorcontrib><creatorcontrib>Le Monnier, A.</creatorcontrib><creatorcontrib>Morand, P.</creatorcontrib><creatorcontrib>Zahar, J.R.</creatorcontrib><creatorcontrib>on behalf the Groupe de microbiologie clinique</creatorcontrib><title>Gram-negative bacteremia: Which empirical antibiotic therapy?</title><title>Médecine et maladies infectieuses</title><addtitle>Med Mal Infect</addtitle><description>Given the increasing frequency of cefotaxime-resistant strains, third-generation cephalosporins (3GC e.g. cefotaxime, ceftriaxone) might not be recommended any longer as empirical antibiotic therapy for community-acquired Gram-negative bacteremia (CA-GNB).
We conducted a multicenter prospective descriptive study including patients with CA-GNB.
Two hundred and nineteen patients were included. Escherichia coli and Pseudomonas aeruginosa were the most frequently isolated species in 63% (n=138) and 11% (n=24) of the cases, respectively. The prevalence of cefotaxime-resistance reached 18% (n=39) mostly due to intrinsic resistance (27 cases, 12%). The presence of invasive material (P<0.001), the origin of the patient (Paris region or West of France) (P=0.006), and home health care (P<0.001) were variables predicting resistant GNB. The negative predictive value for resistance in patients with invasive material coming from the West of France, or without invasive material and with home health care was 94%. The positive predictive value for patients with invasive material living in Paris, or without invasive material and with home health care only reached 58 and 54%, respectively.
Using 3GC for CA-GNB due to cefotaxime-resistant strains was relatively frequent, ESBL-producing Enterobacteriaceae being rarely involved. Our study highlights the role of local epidemiology; before any changes to first-line antibiotic therapy, local epidemiological data should be taken into account.
La diffusion des bacilles à gram négatif résistant aux antibiotiques en communautaire nous questionne sur le choix probabiliste recommandé des céphalosporines de 3e génération (C3G, i.e. céfotaxime, ceftriaxone) dans les bactériémies communautaires à bacille à Gram négatif (BGN).
Nous avons conduit une étude descriptive prospective multicentrique, incluant les patients admis pour une bactériémie à BGN.
Parmi les 219 patients inclus, les espèces les plus fréquemment isolées étaient Escherichia coli et Pseudomonas aeruginosa dans respectivement 63 (n=138) et 11 % (n=24) des cas. La prévalence des souches résistantes au céfotaxime était de 18 % (n=39), L’existence de matériel invasif (p<0,001), l’origine géographique du patient (Île-de-France [IDF] comparativement à l’ouest de la France) (p=0,006), et les soins à domicile (p<0,001) étaient les variables prédictives d’une bactériémie à BGN résistant. L’association de l’origine géographique du patient (Ouest de la France) à la présence de matériel, ou de l’absence de matériel avec des soins à domicile, avait une valeur prédictive négative de 94 %. La valeur prédictive positive, chez les patients porteurs de matériel et résidant en IDF ou sans matériel et recevant des soins à domicile, n’était que de 58 et 54 %, respectivement.
L’utilisation de C3G en cas de bactériémie à BGN communautaire était relativement fréquente, les entérobactéries produisant des BLSE étant rarement impliquées. L’épidémiologie locale de la résistance est un élément incontournable à prendre en compte avant toute modification de l’antibiothérapie probabiliste.</description><subject>Aged</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibacterial agents</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Bacteremia - drug therapy</subject><subject>Bacterial diseases</subject><subject>Bacterial sepsis</subject><subject>Bactériémie à Gram négatif</subject><subject>Biological and medical sciences</subject><subject>Bêta-lactamase à spectre étendu</subject><subject>Cefotaxime-resistance</subject><subject>Cephalosporin Resistance</subject><subject>Community-Acquired Infections - drug therapy</subject><subject>Enterobacteriaceae</subject><subject>Escherichia coli</subject><subject>Extended-spectrum b-lactamase</subject><subject>Gram-negative bacteremia</subject><subject>Gram-Negative Bacterial Infections - drug therapy</subject><subject>Health care-associated infection</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Medical sciences</subject><subject>Pharmacology. Drug treatments</subject><subject>Prospective Studies</subject><subject>Pseudomonas aeruginosa</subject><subject>Résistance au céfotaxime</subject><issn>0399-077X</issn><issn>1769-6690</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkF1LHDEUhkOp1O3qPygyNwVvZj35mMxEaItIXQXBG0XvQpI5080yH2syK_jvm2W2eleEF87Fec4HDyHfKCwoUHm2XnRYd6ZdMKBiATSFfyIzWkqVS6ngM5kBVyqHsnw6JF9jXAOwxMIXcsiElLQoyhn5sQymy3v8Y0b_gpk1bsSAnTfn2ePKu1WG3cYH70ybmX701g-jd9m4wmA2r7-OyEFj2ojH-zonD1e_7y-v89u75c3lxW3uREnHnEmjGlY0llHrBNQcmVCWVgyYKKGyEpgrOHdlJaWVpq5VoxxHEMBdIW3D5-R02rsJw_MW46g7Hx22relx2EZNCy4qXinKP4AyypkshEyomFAXhhgDNnoTfGfCq6agd471Wk-O9c6xBpqyu3Cyv7C1qf029E9qAr7vAROTuCaY3vn4zlWCcSUhcT8nDpO6F49BR-exd1j7gG7U9eD__8lfOdaaCw</recordid><startdate>20140401</startdate><enddate>20140401</enddate><creator>Shoai Tehrani, M.</creator><creator>Hajage, D.</creator><creator>Fihman, V.</creator><creator>Tankovic, J.</creator><creator>Cau, S.</creator><creator>Day, N.</creator><creator>Visseaux, C.</creator><creator>Carbonnelle, E.</creator><creator>Kouatchet, A.</creator><creator>Cattoir, V.</creator><creator>Nhan, T.X.</creator><creator>Corvec, S.</creator><creator>Jacquier, H.</creator><creator>Jauréguy, F.</creator><creator>Le Monnier, A.</creator><creator>Morand, P.</creator><creator>Zahar, J.R.</creator><general>Elsevier SAS</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QL</scope><scope>7T7</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>P64</scope></search><sort><creationdate>20140401</creationdate><title>Gram-negative bacteremia: Which empirical antibiotic therapy?</title><author>Shoai Tehrani, M. ; Hajage, D. ; Fihman, V. ; Tankovic, J. ; Cau, S. ; Day, N. ; Visseaux, C. ; Carbonnelle, E. ; Kouatchet, A. ; Cattoir, V. ; Nhan, T.X. ; Corvec, S. ; Jacquier, H. ; Jauréguy, F. ; Le Monnier, A. ; Morand, P. ; Zahar, J.R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c471t-26a9f25fb21bc40d3e249b182024708b602c533c7866b6add9f9c3e0403c56bf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibacterial agents</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Bacteremia - drug therapy</topic><topic>Bacterial diseases</topic><topic>Bacterial sepsis</topic><topic>Bactériémie à Gram négatif</topic><topic>Biological and medical sciences</topic><topic>Bêta-lactamase à spectre étendu</topic><topic>Cefotaxime-resistance</topic><topic>Cephalosporin Resistance</topic><topic>Community-Acquired Infections - drug therapy</topic><topic>Enterobacteriaceae</topic><topic>Escherichia coli</topic><topic>Extended-spectrum b-lactamase</topic><topic>Gram-negative bacteremia</topic><topic>Gram-Negative Bacterial Infections - drug therapy</topic><topic>Health care-associated infection</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Medical sciences</topic><topic>Pharmacology. 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We conducted a multicenter prospective descriptive study including patients with CA-GNB.
Two hundred and nineteen patients were included. Escherichia coli and Pseudomonas aeruginosa were the most frequently isolated species in 63% (n=138) and 11% (n=24) of the cases, respectively. The prevalence of cefotaxime-resistance reached 18% (n=39) mostly due to intrinsic resistance (27 cases, 12%). The presence of invasive material (P<0.001), the origin of the patient (Paris region or West of France) (P=0.006), and home health care (P<0.001) were variables predicting resistant GNB. The negative predictive value for resistance in patients with invasive material coming from the West of France, or without invasive material and with home health care was 94%. The positive predictive value for patients with invasive material living in Paris, or without invasive material and with home health care only reached 58 and 54%, respectively.
Using 3GC for CA-GNB due to cefotaxime-resistant strains was relatively frequent, ESBL-producing Enterobacteriaceae being rarely involved. Our study highlights the role of local epidemiology; before any changes to first-line antibiotic therapy, local epidemiological data should be taken into account.
La diffusion des bacilles à gram négatif résistant aux antibiotiques en communautaire nous questionne sur le choix probabiliste recommandé des céphalosporines de 3e génération (C3G, i.e. céfotaxime, ceftriaxone) dans les bactériémies communautaires à bacille à Gram négatif (BGN).
Nous avons conduit une étude descriptive prospective multicentrique, incluant les patients admis pour une bactériémie à BGN.
Parmi les 219 patients inclus, les espèces les plus fréquemment isolées étaient Escherichia coli et Pseudomonas aeruginosa dans respectivement 63 (n=138) et 11 % (n=24) des cas. La prévalence des souches résistantes au céfotaxime était de 18 % (n=39), L’existence de matériel invasif (p<0,001), l’origine géographique du patient (Île-de-France [IDF] comparativement à l’ouest de la France) (p=0,006), et les soins à domicile (p<0,001) étaient les variables prédictives d’une bactériémie à BGN résistant. L’association de l’origine géographique du patient (Ouest de la France) à la présence de matériel, ou de l’absence de matériel avec des soins à domicile, avait une valeur prédictive négative de 94 %. La valeur prédictive positive, chez les patients porteurs de matériel et résidant en IDF ou sans matériel et recevant des soins à domicile, n’était que de 58 et 54 %, respectivement.
L’utilisation de C3G en cas de bactériémie à BGN communautaire était relativement fréquente, les entérobactéries produisant des BLSE étant rarement impliquées. L’épidémiologie locale de la résistance est un élément incontournable à prendre en compte avant toute modification de l’antibiothérapie probabiliste.</abstract><cop>Paris</cop><pub>Elsevier SAS</pub><pmid>24661557</pmid><doi>10.1016/j.medmal.2014.01.013</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0399-077X |
| ispartof | Médecine et maladies infectieuses, 2014-04, Vol.44 (4), p.159-166 |
| issn | 0399-077X 1769-6690 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1534838913 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Aged Anti-Bacterial Agents - therapeutic use Antibacterial agents Antibiotics. Antiinfectious agents. Antiparasitic agents Bacteremia - drug therapy Bacterial diseases Bacterial sepsis Bactériémie à Gram négatif Biological and medical sciences Bêta-lactamase à spectre étendu Cefotaxime-resistance Cephalosporin Resistance Community-Acquired Infections - drug therapy Enterobacteriaceae Escherichia coli Extended-spectrum b-lactamase Gram-negative bacteremia Gram-Negative Bacterial Infections - drug therapy Health care-associated infection Human bacterial diseases Humans Infectious diseases Medical sciences Pharmacology. Drug treatments Prospective Studies Pseudomonas aeruginosa Résistance au céfotaxime |
| title | Gram-negative bacteremia: Which empirical antibiotic therapy? |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-10T07%3A02%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Gram-negative%20bacteremia:%20Which%20empirical%20antibiotic%20therapy?&rft.jtitle=Me%CC%81decine%20et%20maladies%20infectieuses&rft.au=Shoai%20Tehrani,%20M.&rft.aucorp=on%20behalf%20the%20Groupe%20de%20microbiologie%20clinique&rft.date=2014-04-01&rft.volume=44&rft.issue=4&rft.spage=159&rft.epage=166&rft.pages=159-166&rft.issn=0399-077X&rft.eissn=1769-6690&rft.coden=MMAIB5&rft_id=info:doi/10.1016/j.medmal.2014.01.013&rft_dat=%3Cproquest_cross%3E1534838913%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1521326546&rft_id=info:pmid/24661557&rft_els_id=S0399077X14000274&rfr_iscdi=true |