Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care—an analysis of the OUTCOMEREA database
Anne-Cécile Morvan
(1)
,
Baptiste Hengy
(1)
,
Maïté Garrouste-Orgeas
(2)
,
Stephane Ruckly
(3)
,
Jean-Marie Forel
(4)
,
Laurent Argaud
(5)
,
Thomas Rimmelé
(6)
,
Jean-Pierre Bedos
(7)
,
Elie Azoulay
(8)
,
Claire Dupuis
(9)
,
Bruno Mourvillier
(10)
,
Carole Schwebel
(11)
,
Jean-François Timsit
(12)
1
Hôpital Edouard Herriot [CHU - HCL]
2 Medical-Surgical ICU
3 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
4 DRIS - Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM]
5 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
6 Agressions vasculaires et réponses tissulaires
7 Unité de Soins Intensifs [CH Versailles]
8 Service de réanimation médicale
9 Service d'Anesthésie et Soins Intensifs
10 Medical-Surgical ICU
11 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
12 Clinique de réanimation médicale
2 Medical-Surgical ICU
3 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
4 DRIS - Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM]
5 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
6 Agressions vasculaires et réponses tissulaires
7 Unité de Soins Intensifs [CH Versailles]
8 Service de réanimation médicale
9 Service d'Anesthésie et Soins Intensifs
10 Medical-Surgical ICU
11 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
12 Clinique de réanimation médicale
Jean-Marie Forel
- Fonction : Auteur
- PersonId : 760690
- ORCID : 0000-0002-1958-7388
Elie Azoulay
- Fonction : Auteur
- PersonId : 1189025
- ORCID : 0000-0002-8162-1508
- IdRef : 066920515
Claire Dupuis
- Fonction : Auteur
- PersonId : 1100666
- IdHAL : claire-dupuis
- ORCID : 0000-0002-3533-3097
Jean-François Timsit
- Fonction : Auteur
- PersonId : 758651
- ORCID : 0000-0002-6063-7383
- IdRef : 077116313
Résumé
Introduction: Enterococcus species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subjected to debate, except in septic shock. The aim of our study was to evaluate whether an IAT that did not cover Enterococcus spp. was associated with 30-day mortality in ICU patients presenting with IAI growing with Enterococcus spp.
Material and methods: Retrospective analysis of French database OutcomeRea from 1997 to 2016. We included all patients with IAI with a peritoneal sample growing with Enterococcus. Primary endpoint was 30-day mortality.
Results: Of the 1017 patients with IAI, 76 (8%) patients were included. Thirty-day mortality in patients with inadequate IAT against Enterococcus was higher (7/18 (39%) vs 10/58 (17%), p = 0.05); however, the incidence of postoperative complications was similar. Presence of Enterococcus spp. other than E. faecalis alone was associated with a significantly higher mortality, even greater when IAT was inadequate. Main risk factors for having an Enterococcus other than E. faecalis alone were as follows: SAPS score on day 0, ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI especially with third-generation cephalosporins. Univariate analysis found a higher hazard ratio of death with an Enterococcus other than E. faecalis alone that had an inadequate IAT (HR = 4.4 [1.3-15.3], p = 0.019) versus an adequate IAT (HR = 3.1 [1.0-10.0], p = 0.053). However, after adjusting for confounders (i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and adequacy of IAT for other germs), the impact of the adequacy of IAT was no longer significant in multivariate analysis. Septic shock at diagnosis and ICU-acquired IAI were prognostic factors.
Conclusion: An IAT which does not cover Enterococcus is associated with an increased 30-day mortality in ICU patients presenting with an IAI growing with Enterococcus, especially when it is not an E. faecalis alone. It seems reasonable to use an IAT active against Enterococcus in severe postoperative ICU-acquired IAI, especially when a third-generation cephalosporin has been used within 3 months.
Format du dépôt | Fichier |
---|---|
Type de dépôt | Article dans une revue |
Titre |
en
Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care—an analysis of the OUTCOMEREA database
|
Résumé |
en
Introduction: Enterococcus species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subjected to debate, except in septic shock. The aim of our study was to evaluate whether an IAT that did not cover Enterococcus spp. was associated with 30-day mortality in ICU patients presenting with IAI growing with Enterococcus spp.
Material and methods: Retrospective analysis of French database OutcomeRea from 1997 to 2016. We included all patients with IAI with a peritoneal sample growing with Enterococcus. Primary endpoint was 30-day mortality.
Results: Of the 1017 patients with IAI, 76 (8%) patients were included. Thirty-day mortality in patients with inadequate IAT against Enterococcus was higher (7/18 (39%) vs 10/58 (17%), p = 0.05); however, the incidence of postoperative complications was similar. Presence of Enterococcus spp. other than E. faecalis alone was associated with a significantly higher mortality, even greater when IAT was inadequate. Main risk factors for having an Enterococcus other than E. faecalis alone were as follows: SAPS score on day 0, ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI especially with third-generation cephalosporins. Univariate analysis found a higher hazard ratio of death with an Enterococcus other than E. faecalis alone that had an inadequate IAT (HR = 4.4 [1.3-15.3], p = 0.019) versus an adequate IAT (HR = 3.1 [1.0-10.0], p = 0.053). However, after adjusting for confounders (i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and adequacy of IAT for other germs), the impact of the adequacy of IAT was no longer significant in multivariate analysis. Septic shock at diagnosis and ICU-acquired IAI were prognostic factors.
Conclusion: An IAT which does not cover Enterococcus is associated with an increased 30-day mortality in ICU patients presenting with an IAI growing with Enterococcus, especially when it is not an E. faecalis alone. It seems reasonable to use an IAT active against Enterococcus in severe postoperative ICU-acquired IAI, especially when a third-generation cephalosporin has been used within 3 months.
|
Auteur(s) |
Anne-Cécile Morvan
1
, Baptiste Hengy
1
, Maïté Garrouste-Orgeas
2
, Stephane Ruckly
3
, Jean-Marie Forel
4
, Laurent Argaud
5
, Thomas Rimmelé
6
, Jean-Pierre Bedos
7
, Elie Azoulay
8
, Claire Dupuis
9
, Bruno Mourvillier
10
, Carole Schwebel
11
, Jean-François Timsit
12
1
Hôpital Edouard Herriot [CHU - HCL]
( 300094 )
- 5 Place d'Arsonval
69003 Lyon
- France
2
Medical-Surgical ICU
( 41424 )
- France
3
IAME (UMR_S_1137 / U1137) -
Infection, Anti-microbiens, Modélisation, Evolution
( 247341 )
- Faculté de médecine Paris Diderot Paris 7 - site Bichat - 16 rue Henri Huchard 75890 Paris Cedex 18
- France
4
DRIS -
Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM]
( 85012 )
- Hôpital Nord - Chemin des Bourrely, 13015 Marseille
- France
5
CarMeN -
Cardiovasculaire, métabolisme, diabétologie et nutrition
( 139835 )
- Faculté de Médecine Lyon Sud - BP 12 - 165 Chemin du Grand Revoyet - 69921 Oullins cedex INSA, Bât. IMBL, La Doua - 11 Avenue Jean Capelle - 69621 Villeurbanne Cedex
- France
6
Agressions vasculaires et réponses tissulaires
( 27771 )
- domaine rockefeller 8, avenue rockfeller 69373 LYON CEDEX 08
- France
7
Unité de Soins Intensifs [CH Versailles]
( 207849 )
- 177 rue de Versailles 78150 Le Chesnay
- France
8
Service de réanimation médicale
( 94376 )
- 1 rue Claude Vellefaux 75011 Paris
- France
9
Service d'Anesthésie et Soins Intensifs
( 240612 )
- 2 rue Ambroise-Paré 75475 Paris Cedex 10
- France
10
Medical-Surgical ICU
( 81277 )
- Paris
- France
11
CHUGA -
Centre Hospitalier Universitaire [CHU Grenoble]
( 257328 )
- CS 10217
38043 Grenoble cedex 9
- France
12
Clinique de réanimation médicale
( 84982 )
- France
|
Page/Identifiant |
307
|
Volume |
23
|
Date de publication |
2019
|
Date de publication électronique |
2019-09-06
|
Comité de lecture |
Oui
|
Audience |
Internationale
|
Langue du document |
Anglais
|
Nom de la revue |
|
Vulgarisation |
Non
|
Domaine(s) |
|
Mots-clés |
en
Mortality, Enterococcus spp., Antibiotic therapy, Intensive care, Intraabdominal infections
|
DOI | 10.1186/s13054-019-2581-8 |
Origine :
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