Patterns of Antimicrobial Therapy in Severe Nosocomial Infections: Empiric Choices, Proportion of Appropriate Therapy, and Modification Rates–A Multicenter, Observational Survey in Critically Ill Patients. - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue International Journal of Antimicrobial Agents Année : 2010

Patterns of Antimicrobial Therapy in Severe Nosocomial Infections: Empiric Choices, Proportion of Appropriate Therapy, and Modification Rates–A Multicenter, Observational Survey in Critically Ill Patients.

Résumé

This prospective, observational multicenter (n=24) study investigated relationships between antimicrobial choices and rates of empiric appropriate or adequate therapy, and subsequent modification of therapy in 171 ICU patients with severe nosocomial infections. Appropriate antibiotic therapy was defined as in-vitro susceptibility of the causative pathogen and clinical response to the agent administered. In non-microbiologically documented infections, therapy was considered adequate in the case of favorable clinical response <5 days. Patients had pneumonia (n=127; 66 ventilator-associated), intra-abdominal infection (n=23), and bloodstream infection (n=21). Predominant pathogens were (n=29) (n=26), (n=22), and (n=21). In 49.6% of infections multidrug resistant (MDR) bacteria were involved, mostly extended-spectrum Beta-lactamase producing Enterobacteriaceae and MDR non-fermenting Gram-negative bacteria. Prior antibiotic exposure and hospitalization in a general ward prior to ICU admission were risk factors for MDR. Empiric therapy was appropriate/adequate in 63.7% of cases. Empiric schemes were classified according to coverage of (i) ESBL-producing Enterobacteriaceae and non-fermenting Gram-negative bacteria (“meropenem-based”), (ii) non-fermenting Gram-negative bacteria (schemes with an antipseudomonal agent), and (iii) first-line agents not covering ESBL-Enterobacteriaceae nor non-fermenting Gram-negative bacteria. Meropenem-based schemes allowed for significantly higher rates of appropriate/adequate therapy (p<0.001). This benefit remained when only patients without risk factors for MDR were considered (p=0.021). In 106 patients (61%) empiric therapy was modified: in 60 cases following initial inappropriate/inadequate therapy, in 46 patients in order to refine empiric therapy. In this study which reflects real-life practice, first-line use of meropenem provided significantly higher rates of the appropriate/adequate therapy, irrespective of presence of risk factors for MDR.
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Dates et versions

hal-00567278 , version 1 (20-02-2011)

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Dirk Vogelaers, David de Bels, Frédéric Forêt, Sophie Cran, Eric Gilbert, et al.. Patterns of Antimicrobial Therapy in Severe Nosocomial Infections: Empiric Choices, Proportion of Appropriate Therapy, and Modification Rates–A Multicenter, Observational Survey in Critically Ill Patients.. International Journal of Antimicrobial Agents, 2010, 35 (4), pp.375. ⟨10.1016/j.ijantimicag.2009.11.015⟩. ⟨hal-00567278⟩

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