Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae

Zahar, Jean‐Ralph; Ruckly, Stéphane; Timsit, Jean‐François; Brun‐Buisson, Christian; Aissa, Nejla; Losniewski, Alain; Henard, Sandrine; Rabaud, Christian; Janßen, C.; Pagani, Léonardo; Bland, Stéphane; Gaillat, J.; Bru, Jean Pierre; Bonnin, P.; Clavere, Gaëlle; Vitrat, Virginie; Maulin, Laurence; Quarsaet, Luc; Roger, H.; Euzen, Jean-Baptiste; Dénes, E.; Couve-Daecon, Elodie; Lechiche, Catherine; Lavigne, Jean‐Philippe; Mondain, V.; Pulcini, Céline; Garnier, V. Vernet; Lambert, D.; Hentzien, Maxime; Nguyen, Yohan; Talarmin, Jean Paul; Rameau, Pascaline; Geffroy, Françoise; Salmon-Rousseau, Arnaud; Cattoir, Vincent; Froissart, Antoine; Aberrane, Saïd; Legout, L.; Roblot, F.; Béraud, Guillaume; Pavèse, Patricia; Belmonte, Olivier; Traversier, Nicolas; Bellec, L.; Lagrange-Xélot, Marie; Moiton, Marie‐Pierre; Kuli, B.; Longuet, Pascal; Scanvic, A.; Colombain, L.; Ferreyra, Milagros; Jean, Maxime; Eden, A.; Laurens, E.; Saada, M.; Aumaître, Hugues; Malet, Martine; Roustant, F.; Lemoing, Vincent; Helene, Jean-Pierre; Theodore, Jonathan; Garandeau, Caroline; Caillon, Jocelyne; Olivero, Benjamin; Boutoille, David; Lepelletier, Didier; Grandière-Pérez, L.; Beaudron, Aurelie; Ramanantsoa, Céline; Varache, C.; Varache, N.; Crochette, N.; Hitoto, Hikombo; Blanchi, Sophie; Penn, Pascale; Louis, Bengyella; Vanjak, Dominique; Escande, Marie-Christine; Patrigeon, René-Gilles; Honore, Stéphanie; Barrelet, Audrey; Amara, Marlène; Galempoix, J.M.; Reveil, J.C.; Bucchiotty, Patricia; Couzigou, C.; Monnier, Alban Le; Boidin, Emilie; Sire, Stéphane; Luizy, Nelly; Bronstain, Caroline; Harbarth, Stéphan Juergen; Fankhauser, Carolina; Brossier, Caroline; Dach, Elodie von; Sauve, Colette; Adam, M. N.; Hocqueloux, Laurent; Bret, Laurent; André, M.; Barruet, R.; Challier, Marion; Cabie, André; Rozé, B.; Plésiat, Patrick; Jeanot, Katy; Patry, Isabelle; Moreau, J.; Chirouze, Catherine; Aaron, Laurent; Bachelier, Marie-Nadège; Kac, G.; Farthouat, Nicolas; Feuillebois, Nicolas; Guimard, Thomas; Bourdon, Sandra; Nguyen, S.; Alfandari, S.; Bentayeb, H.; Albertini, M T; Marchou, B.; Gaudré, N.; Dubois, Damien; Guillet-Caruba, Christelle; Populaire, Florence Doucet; Fortineau, Nicolas; Escaut, Leila; Lesprit, Philippe; Fihman, Vincent; Gauzit, R.; Raymond, Josette; Kerneis, Solene; Leflon‐Guibout, Véronique; Lefort, A.; Roux, Anne-Laure; Abgrall, Sophie; Jauréguy, Françoise; Lucet, Jean‐Christophe; Dinh, Aurélien; Soismier, Nathalie; Lopes, Amanda; Cambau, Emmanuelle; Manceron, V.; Barnaud, Guilène

doi:10.1016/j.ijantimicag.2016.09.032

Cited by 25 publications

(13 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Numerous studies suggest a preliminary colonization step as a mandatory prerequisite for the development of infection related to MDR Enterobacteriaceae [78]. Furthermore, only a few studies focused on the risk factors associated with MDR Enterobacteriaceae in previously colonized patients [90,91]. In a retrospective case-controlled study, conducted out of ICU and including pediatric and adult patients, authors identified two factors associated with ESBL producing an Escherichia coli related infection in previously colonized patients.…”

Section: From Colonization To Infectionmentioning

confidence: 99%

Gut Microbiota, Antibiotic Therapy and Antimicrobial Resistance: A Narrative Review

2020

Self Cite

View full text Add to dashboard Cite

Antimicrobial resistance is a major concern. Epidemiological studies have demonstrated direct relationships between antibiotic consumption and emergence/dissemination of resistant strains. Within the last decade, authors confounded spectrum activity and ecological effects and did not take into account several other factors playing important roles, such as impact on anaerobic flora, biliary elimination and sub-inhibitory concentration. The ecological impact of antibiotics on the gut microbiota by direct or indirect mechanisms reflects the breaking of the resistance barrier to colonization. To limit the impact of antibiotic therapy on gut microbiota, consideration of the spectrum of activity and route of elimination must be integrated into the decision. Various strategies to prevent (antimicrobial stewardship, action on residual antibiotics at colonic level) or cure dysbiosis (prebiotic, probiotic and fecal microbiota transplantation) have been introduced or are currently being developed.

show abstract

Section: From Colonization To Infectionmentioning

confidence: 99%

Gut Microbiota, Antibiotic Therapy and Antimicrobial Resistance: A Narrative Review

2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…In a recent prospective cohort study aiming to identify risk factors associated with ESBL-positive strains in case of community onset of bacteremia due to Enterobacteriaceae, a high incidence in the regional area, history of travel to a high-risk country within past 3 years, and previous antianaerobic antibiotic administration were associated with health care-associated bloodstream infection caused by ESBL-PE. 38 In hospitalized patients, the risk of infection in patients previously known to be colonized with ESBL-positive Escherichia coli is less than 9%. 39 In multivariate analysis in previously colonized patients, the risk factors associated with secondary infections were the use of β-lactam/βlactamase inhibitor (BL/BLI) before infection (OR: 3.2, 95% CI: 1.073-9.864); p ¼ 0.037 and urinary catheterization (OR: 5.2, 95% CI: 1.984-13.569).…”

Section: Risk Factors For Carriagementioning

confidence: 99%

How Should We Treat Hospital-Acquired and Ventilator-Associated Pneumonia Caused by Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae?

Timsit

Pilmis

Zahar

2017

Semin Respir Crit Care Med

Self Cite

View full text Add to dashboard Cite

Hospital-acquired and ventilator-associated pneumonia (HAP/VAP) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) represent a growing problem. Indeed, ESBL-PE is endemic in many countries, and 5 to 25% of intensive care unit (ICU) patients are ESBL-PE carrier on ICU admission. ESBL-PE HAP/VAP is associated with a higher mortality than HAP/VAP due to susceptible Enterobacteriaceae because the resistance profile decreases the adequacy rate of empiric therapy. ESBL-PE should be considered in the empirical treatment in case of the high burden of ESBL-PE in the unit, in the case of previous ESBL-PE colonization, when the HAP/VAP occurs late, and in patients with shock. A negative active systematic surveillance culture on rectal swab reduced the risk of ESBL-PE VAP to less than 1%. Rapid diagnostic tests are now able to confirm the presence of ESBL-PE in VAP within 24 hours; new molecular methods will provide results within few hours.Adequate treatment usually required carbapenems. The alternative β-lactams such as β-lactams/β-lactamases inhibitor combinations could be proposed as a step-down therapy according to the antibiotic susceptibility result. Optimization of pharmacokinetics requires high dosage and continuous or prolonged infusions for β-lactams. When the patient is stabilized, a therapy of duration 7 to 8 days is recommended.

show abstract

“…A multicentric observational study of 682 community-onset Enterobacteriaceae bloodstream infections done by Zahar et al pointed out that despite 8.5% being caused by ESBL producing bacteria, almost two-thirds of these infections were actually healthcare-acquired, and the main risk factor of community-onset ESBL-positive bacteraemia was a hospital stay within one year. The authors concluded that true community-acquired bloodstream infections with ESBL-positive isolates remain rare [31]. In summary, CAS episodes caused by MDR pathogens should be acknowledged, but a dominant proportion of these cases is probably community-onset, healthcare-acquired sepsis.…”

Section: Discussionmentioning

confidence: 99%

Clinical and microbiological characteristics and outcomes of community-acquired sepsis among adults: a single center, 1-year retrospective observational cohort study from Hungary

et al. 2019

View full text Add to dashboard Cite

Background Community-acquired sepsis is a life-threatening systemic reaction, which starts within ≤72 h of hospital admittance in an infected patient without recent exposure to healthcare risks. Our aim was to evaluate the characteristics and the outcomes concerning community-acquired sepsis among patients admitted to a Hungarian high-influx national medical center. Methods A retrospective, observational cohort study of consecutive adult patients hospitalized with community-acquired sepsis during a 1-year period was executed. Clinical and microbiological data were collected, patients with pre-defined healthcare associations were excluded. Sepsis definitions and severity were given according to ACCP / SCCM criteria. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were intensive care unit (ICU) admittance, length-of-stay (LOS), source control and bacteraemia rates. Statistical differences were explored with classical comparison tests, predictors of in-hospital all-cause mortality were modelled by multivariate logistic regression. Results 214 patients (median age 60.0 ± 33.1 years, 57% female, median Charlson score 4.0 ± 5.0) were included, 32.7% of them (70/214) had severe sepsis, and 28.5% (61/214) had septic shock. Prevalent sources of infections were genitourinary (53/214, 24.8%) and abdominal (52/214, 24.3%). The causative organisms were dominantly E. coli (60/214, 28.0%), S. pneumoniae (18/214, 8.4%) and S. aureus (14/214, 6.5%), and bacteraemia was documented in 50.9% of the cases (109/214). In-hospital mortality was high (30/214, 14.0%), and independently associated with shock, absence of fever, male gender and the need for ICU admittance, but source control and de-escalation of empirical antimicrobial therapy were protective. ICU admittance was 27.1% (58/214), source control was achieved in 18.2% (39/214). Median LOS was 10.0 ± 8.0, ICU LOS was 8.0 ± 10.8 days. Conclusions Community-acquired sepsis poses a significant burden of disease with characteristic causative agents and sources. Patients at a higher risk for poor outcomes might be identified earlier by the contributing factors shown above.

show abstract

Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae

Cited by 25 publications

References 36 publications

Gut Microbiota, Antibiotic Therapy and Antimicrobial Resistance: A Narrative Review

Gut Microbiota, Antibiotic Therapy and Antimicrobial Resistance: A Narrative Review

How Should We Treat Hospital-Acquired and Ventilator-Associated Pneumonia Caused by Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae?

Clinical and microbiological characteristics and outcomes of community-acquired sepsis among adults: a single center, 1-year retrospective observational cohort study from Hungary

Contact Info

Product

Resources

About