Efficacy of carbapenem vs non carbapenem β-lactam therapy as empiric antimicrobial therapy in patients with extended-spectrum β-lactamase-producing Enterobacterales urinary septic shock: a propensity-weighted multicenter cohort study - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Annals of Intensive Care Année : 2023

Efficacy of carbapenem vs non carbapenem β-lactam therapy as empiric antimicrobial therapy in patients with extended-spectrum β-lactamase-producing Enterobacterales urinary septic shock: a propensity-weighted multicenter cohort study

Basit Azizi
  • Fonction : Auteur
Ricardo Munoz-Acuna
  • Fonction : Auteur
Aiman Suleiman
  • Fonction : Auteur
Elena Ahrens
  • Fonction : Auteur
Simone Redaelli
  • Fonction : Auteur
Tim Tartler
  • Fonction : Auteur
Guanqing Chen
  • Fonction : Auteur
Daniel Talmor
  • Fonction : Auteur
Elias Baedorf-Kassis
  • Fonction : Auteur
Maximilian Schaefer

Résumé

Abstract Background The rise in antimicrobial resistance is a global threat responsible for about 33,000 deaths in 2015 with a particular concern for extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and has led to a major increase in the use of carbapenems, last-resort antibiotics. Methods In this retrospective propensity-weighted multicenter observational study conducted in 11 ICUs, the purpose was to assess the efficacy of non carbapenem regimen (piperacillin–tazobactam (PTZ) + aminoglycosides or 3rd-generation cephalosporin (3GC) + aminoglycosides) as empiric therapy in comparison with carbapenem in extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) urinary septic shock. The primary outcome was Day-30 mortality. Results Among 156 patients included in this study, 69 received a carbapenem and 87 received non carbapenem antibiotics as empiric treatment. Baseline clinical characteristics were similar between the two groups. Patients who received carbapenem had similar Day-30 mortality (10/69 (15%) vs 6/87 (7%), OR = 1.99 [0.55; 5.34] p = 0.16), illness severity, resolution of septic shock, and ESBL-E infection recurrence rates than patients who received an empiric non carbapenem therapy. The rates of secondary infection with C. difficile were comparable. Conclusions In ESBL-E urinary septic shock, empiric treatment with a non carbapenem regimen, including systematically aminoglycosides, was not associated with higher mortality, compared to a carbapenem regimen.
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hal-04071735 , version 1 (21-11-2023)

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Basit Azizi, Ricardo Munoz-Acuna, Aiman Suleiman, Elena Ahrens, Simone Redaelli, et al.. Efficacy of carbapenem vs non carbapenem β-lactam therapy as empiric antimicrobial therapy in patients with extended-spectrum β-lactamase-producing Enterobacterales urinary septic shock: a propensity-weighted multicenter cohort study. Annals of Intensive Care, 2023, 13 (1), pp.22. ⟨10.1186/s13613-023-01106-z⟩. ⟨hal-04071735⟩
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