Acquisition of carbapenem-resistant Gram-negative bacilli in intensive care unit: Predictors and molecular epidemiology

Marchenay, P.; Blasco, Gilles; Navellou, JC; Leroy, J.; Cholley, Pascal; Talon, D.; Bertrand, Xavier; Gbaguidi‐Haore, Houssein

doi:10.1016/j.medmal.2014.12.003

Cited by 17 publications

(22 citation statements)

References 26 publications

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“…Inclusion criteria were only admission to an ICU, whereas we choose initiation of carbapenem therapy. Exposure to antibiotics, including carbapenem, was the main risk factor reported [21,22]; hence, we focused specifically on patients exposed to these antibiotics. Some authors have considered the Stenotrophomonas maltophilia colonization/infection as a factor contributing to acquisition of bacterial resistance [20,21].…”

Section: Discussionmentioning

confidence: 99%

“…Exposure to antibiotics, including carbapenem, was the main risk factor reported [21,22]; hence, we focused specifically on patients exposed to these antibiotics. Some authors have considered the Stenotrophomonas maltophilia colonization/infection as a factor contributing to acquisition of bacterial resistance [20,21]. Given the natural resistance of S. maltophilia to carbapenems, we considered positive samples to be the result of a simple selection process and, hence, did not take them into account in our study.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for acquisition of carbapenem-resistance during treatment with carbapenem in the intensive care unit: a prospective study

Labaste

Grossac

Vardon-Bounes

et al. 2019

Eur J Clin Microbiol Infect Dis

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The emergence of carbapenemases in gram-negative aerobes is worrying. The aim of this prospective study was to estimate the incidence of acquisition of carbapenem-resistance during treatment in ICU and to identify the risk factors. This was a prospective, observational, cohort study. This study was conducted at intensive care unit, academic medical center, Toulouse Rangueil University Hospital. Patients were included if they received antibiotic treatment with carbapenem for more than 48 h. Biological samples were taken in accordance with current practice in the unit. The main endpoint was the occurrence of bacterial resistance to carbapenems occurring between the onset of treatment and the patient's exit from the ICU. Uni-and multi-variate analyses were carried out. Of the 364 patients admitted to the unit between May and November 2014, 78 were included in our study and 16 (20.51%) developed resistance. The two main risk factors were a length of stay in ICU of more than 29 days (HR = 3.61, p = 0.01) and the presence of Pseudomonas aeruginosa in the samples taken before the start of treatment (HR = 5.31, p = 0.002). No resistance due to carbapenemase production was observed in this study. The prescription of carbapenems in the ICU setting must adhere to the expert guidelines. In light of our results, special attention must be paid to patients whose stay in intensive care is prolonged, and those in whom Pseudomonas aeruginosa is isolated from bacteriological samples taken before the beginning of antibiotic therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors for acquisition of carbapenem-resistance during treatment with carbapenem in the intensive care unit: a prospective study

Labaste

Grossac

Vardon-Bounes

et al. 2019

Eur J Clin Microbiol Infect Dis

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“…At the population level, the incidence of CR enterobacteria was negatively associated with TZP use in a 5-year, single-hospital trend analysis study 45 . At the patient level, however, TZP exposure was associated with CRPA in a meta-analysis 46 and with CR Gramnegative bacilli in a single-hospital prospective cohort study 47 . Our finding that TZP use correlates with both 3GCR and CR infections, more strongly so than carbapenems and CTX/CRO, challenges the rationale of recommending TZP over other drugs for ecological reasons.…”

Section: Discussionmentioning

confidence: 95%

Metapopulation ecology links antibiotic resistance, consumption and patient transfers in a network of hospital wards

Shapiro

Leboucher

Myard-Dury

et al. 2019

Preprint

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Antimicrobial resistance (AMR) is a global threat. A better understanding of how antibiotic use and betweenward patient transfers (or connectivity) impact hospital AMR can help optimize antibiotic stewardship and infection control strategies. Here, we used metapopulation ecology to explain variations in infection incidences of 17 ESKAPE pathogen variants in a network of 357 hospital wards. Multivariate models identified the strongest influence of ward-level antibiotic use on more resistant variants, and of connectivity on nosocomial species and carbapenem-resistant variants. Pairwise associations between infection incidence and the consumption of specific antibiotics were significantly stronger when such associations represented a priori AMR selection, suggesting that AMR evolves within the network. Piperacillin-tazobactam consumption was the strongest predictor of the cumulative incidence of infections resistant to empirical sepsis therapy. Our data establish that both antibiotic use and connectivity measurably influence hospital AMR and provide a ranking of key antibiotics by their impact on AMR.

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“…Potential confounders were selected based on previous literature [20][21][22], and included age, gender, principal diagnosis, tumor, liver failure, kidney failure, heart failure, respiratory failure, diabetes, hypertension, chronic obstructive pulmonary disease, hemodialysis, venous catheterization, mechanical ventilation, urinary catheterization, tracheotomy, surgery, ICU admission now or in the past and community infections.…”

Section: Confounding Factorsmentioning

confidence: 99%

Previous use of quinolones was not significantly correlated with antibiotic-induced carbapenem-resistant Gram-negative bacilli in China: a retrospective cohort study

Chen

Xiang

et al. 2020

Preprint

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Background: Increasing resistance to carbapenem, particularly common in Gram-negative bacilli (GNB), has become a growing public health concern around the world. The objective of this study was to investigate risk factors associated with antibiotic-induced carbapenem-resistant Gram-negative bacilli (CR-GNB) among inpatients.Methods: A retrospective cohort study was conducted in one of the largest tertiary A-level hospitals including patients with GNB cultured from any of the clinical specimens who had been admitted for more than 2 calendar days from January 2017 to June 2019. Kaplan-Meier analysis and Cox proportional hazard model were used to estimate the hazard of CR-GNB induction by antibiotics.Results: 2490 patients including 7 cohorts were included. After cox proportional risk model analysis, carbapenem, β-lactamase inhibitor, and cephalosporin had significantly higher hazards than other types of antimicrobial (P<0.001). But even without using any antimicrobials, the hazard would increase with the length of hospital stay. On multivariate analysis, carbapenem was the most principal hazard factor for antibiotic-induced CR-GNB (hazard ratio [HR], 2.968; 95% confidence interval [CI], 1.706 5.162), followed by ICU admission (HR, 1.815; 95% CI, 1.507 2.186), cephalosporin (HR, 1.605; 95% CI, 1.288 1.999), tracheotomy (HR, 1.563; 95% CI, 1.251 1.952) and β-lactamase inhibitor (HR, 1.542; 95% CI, 1.237 1.921). However, quinolone effects on antibioticinduced CR-GNB were not statistically significant.Conclusions: Prior carbapenem was a strongly risk factor for antibiotic-induced CR-GNB, but quinolone was not associated with that. Rational use of carbapenems should be implemented and antimicrobial stewardship policies should be adjusted according to the characteristics of each hospital.

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Acquisition of carbapenem-resistant Gram-negative bacilli in intensive care unit: Predictors and molecular epidemiology

Cited by 17 publications

References 26 publications

Risk factors for acquisition of carbapenem-resistance during treatment with carbapenem in the intensive care unit: a prospective study

Risk factors for acquisition of carbapenem-resistance during treatment with carbapenem in the intensive care unit: a prospective study

Metapopulation ecology links antibiotic resistance, consumption and patient transfers in a network of hospital wards

Previous use of quinolones was not significantly correlated with antibiotic-induced carbapenem-resistant Gram-negative bacilli in China: a retrospective cohort study

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