Appropriateness of empirical antibiotic prescription for bloodstream infections in an emergency department from 2006 to 2018: impact of the spread of ESBL-producing Enterobacterales.
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ therapeutic use
Bacteremia
/ drug therapy
Bacterial Proteins
/ genetics
Drug Resistance, Bacterial
Emergency Service, Hospital
/ statistics & numerical data
Enterobacteriaceae
/ classification
Enterobacteriaceae Infections
/ drug therapy
Humans
Male
Middle Aged
Prescriptions
Retrospective Studies
beta-Lactamases
/ genetics
Antimicrobial resistance
Antimicrobial treatment
Bacteremia
ESBL
Journal
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
ISSN: 1435-4373
Titre abrégé: Eur J Clin Microbiol Infect Dis
Pays: Germany
ID NLM: 8804297
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
30
07
2021
accepted:
16
09
2021
pubmed:
24
9
2021
medline:
27
1
2022
entrez:
23
9
2021
Statut:
ppublish
Résumé
The spread of ESBL producers in the community may impact the management of patients with bloodstream infections (BSI) involving Enterobacterales in emergency departments. Thus, from 2006 to 2018, data for all BSI episodes involving Enterobacterales from the emergency department of a French teaching hospital were retrospectively included. Antimicrobial susceptibility test results and empirical antibiotic regimens were recorded. Treatment was considered as appropriate if all isolates were susceptible in vitro to at least one prescribed antibiotic. A total of 1369 BSI episodes in 1321 patients was included. Urinary tract infection was the main source of BSI (61%). The prevalence of ESBL producers increased from zero to 9.2/100 Enterobacterales BSI cases (p < 0.001), mainly Escherichia coli (6.9 cases/100 BSI in 2018); and no Klebsiella. Third-generation cephalosporins (3GC) were used most frequently (71.8%) and their use as monotherapy increased during the study period (p < 0.001). The rate of appropriate treatment decreased from 95.8 to 89.2% (p = 0.023). Appropriateness of treatment was greater using two drugs vs one (97.3% vs 89.3%, p < 0.001). Treatments with 3GC were appropriate in 92% and 98.3%, when used alone or with another antibiotic, respectively (p < 0.001). Among inappropriate treatments, 45% concerned 3GC, with 74.6% of them attributable to ESBL production. The spread of ESBL producers in the community had a direct impact on the rate of inappropriate empirical treatment. Local antimicrobial resistance monitoring is required to optimize the management of BSI in emergency departments.
Identifiants
pubmed: 34553311
doi: 10.1007/s10096-021-04351-x
pii: 10.1007/s10096-021-04351-x
doi:
Substances chimiques
Anti-Bacterial Agents
0
Bacterial Proteins
0
beta-Lactamases
EC 3.5.2.6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
71-77Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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