Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Clin Microbiol Infect. 2022 Apr;28(4):558-563. doi: 10.1016/j.cmi.2021.03.034. Epub 2021 Nov 23.
We aimed to evaluate the impact of the 10th version of European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints table, where most antipseudomonal drugs but meropenem are now categorised as "Susceptible, increased exposure" and labelled I, on meropenem prescription for Pseudomonas aeruginosa infections.
In this retrospective single-centre observational study, we analysed antimicrobial therapies prescribed after susceptibility testing in all consecutive adult patients treated for P. aeruginosa infections between 01.08.2019 and 30.07.2020 in Lausanne University Hospital, Switzerland. We collected epidemiological, microbiological, clinical data, antimicrobial therapy, and infectious diseases specialists (IDs) consultations' data. The primary outcome was the prescription of meropenem to treat P. aeruginosa infections after release of susceptibility testing results. Secondary outcomes were: the use of increased dosage for non-meropenem anti-pseudomonal drugs, and IDs' consultations rates after susceptibility testing was made available.
Among the 264 patients included, 40 (15.2%) received meropenem, 3.4% (5/148) before EUCAST update versus 30.2% (35/116) after (p < 0.001). Supervision and counselling from IDs and the use of increased dosages of non-carbapenem antibiotics also increased respectively (40.5% (60/148) vs 62.9% (73/116), P < 0.001); (55.5% (76/148) vs 88.9% (72/116), P < 0.001). Factors associated with these increments could not be adequately modelled.
The change to 2020 EUCAST criteria might be associated with increased odds of meropenem prescription for the treatment of P. aeruginosa infections stressing the need of prescribers' education and the importance of antibiotic stewardship interventions.
我们旨在评估第 10 版欧洲抗菌药物敏感性测试委员会（EUCAST）折点表的影响，该折点表将大多数抗假单胞菌药物（但美罗培南除外）归类为“敏感，增加暴露”并标记为 I，这对治疗铜绿假单胞菌感染的美罗培南处方有何影响。
在这项回顾性单中心观察性研究中，我们分析了瑞士洛桑大学附属医院在 2019 年 8 月 1 日至 2020 年 7 月 30 日期间对所有连续接受铜绿假单胞菌感染治疗的成年患者进行药敏试验后的抗菌治疗。我们收集了流行病学、微生物学、临床数据、抗菌治疗以及传染病专家（IDs）咨询的数据。主要结局是在药敏试验结果发布后，开具美罗培南治疗铜绿假单胞菌感染的处方。次要结局是：非美罗培南抗假单胞菌药物增加剂量的使用，以及在药敏试验可用后 IDs 咨询的频率。
在纳入的 264 名患者中，40 名（15.2%）接受了美罗培南治疗，在 EUCAST 更新前为 3.4%（5/148），而更新后为 30.2%（35/116）（p<0.001）。ID 的监督和咨询以及非碳青霉烯类抗生素的增加剂量的使用也分别增加（40.5%（60/148）vs 62.9%（73/116），p<0.001）；（55.5%（76/148）vs 88.9%（72/116），p<0.001）。不能充分模拟这些增加的因素。
2020 年 EUCAST 标准的改变可能与增加治疗铜绿假单胞菌感染的美罗培南处方的几率有关，这强调了对医生的教育和抗生素管理干预措施的重要性。
