Le Berre Camille, Degrendel Maxime, Houard Marion, Benetazzo Lucie, Vachée Anne, Georges Hugues, Wallet Frederic, Patoz Pierre, Bortolotti Perrine, Nseir Saad, Delannoy Pierre-Yves, Meybeck Agnès
Service de Réanimation et Maladies Infectieuses, Centre Hospitalier de Tourcoing, 135 Rue du Président Coty, 59200 Tourcoing, France.
Unité de Recherche, Centre Hospitalier de Tourcoing, 135 Rue du Président Coty, 59200 Tourcoing, France.
Antibiotics (Basel). 2025 Apr 1;14(4):358. doi: 10.3390/antibiotics14040358.
The optimal duration of antibiotic treatment for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) bloodstream infections (BSI) in intensive care unit (ICU) is not established. We aim to evaluate the frequency and clinical outcomesof a short appropriate antibiotic treatment (≤7 days) (SAT) for ESBL-E BSI acquired in the ICU. We specifically assessed the rate of ESBL-E BSI relapse, and in-ICU mortality.
All patients who acquired ESBL-E BSI in three ICU in Northern France between January 2011 and June 2022 were included in a multicenter retrospective cohort study. The factors associated with prescribing short (SAT, ≤7 days) versus long (LAT, >7 days) antibiotic treatment were analyzed. To evaluate the impact of SAT on mortality in the ICU, an estimation was applied using a Cox model with a time-dependent co-variable adjusted by inverse weighting of the propensity score.
In total, 379 patients were included. The proportion of patients receiving a SAT was 40% in the entire cohort and 25% in survivors beyond 7 days. In bivariate analysis, the factors associated with prescribing a SAT in survivors were shorter pre-bacteremia ICU stay ( = 0.005), lower proportion of chronic renal failure history ( = 0.034), cancer ( = 0.042), or transplantation ( = 0.025), less frequent exposure to carbapenem within 3 months ( = 0.015). There was a higher proportion of septic shock ( = 0.017) or bacteremia secondary to pneumonia ( = 0.003) in the group of survivors receiving a LAT. After adjustment, no difference in survival was found between the two groups (HR: 1.65, 95%CI: 0.91-3.00, = 0.10).
In our cohort, one quarter of patients with ESBL-E bacteremia acquired in the ICU surviving beyond 7 days were treated with a SAT. SAT did not appear to affect survival. Patients who could benefit from a SAT need to be better identified.
重症监护病房（ICU）中产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-E）血流感染（BSI）的最佳抗生素治疗时长尚未确定。我们旨在评估针对ICU获得性ESBL-E BSI进行短程适当抗生素治疗（≤7天）（SAT）的频率及临床结局。我们特别评估了ESBL-E BSI复发率及ICU内死亡率。
2011年1月至2022年6月期间在法国北部三个ICU获得ESBL-E BSI的所有患者纳入一项多中心回顾性队列研究。分析了与开具短程（SAT，≤7天）和长程（LAT，>7天）抗生素治疗相关的因素。为评估SAT对ICU死亡率的影响，采用Cox模型并通过倾向评分的逆加权对时间依赖性协变量进行调整后进行估计。
共纳入379例患者。整个队列中接受SAT治疗的患者比例为40%，7天以上存活患者中这一比例为25%。在双变量分析中，存活患者中与开具SAT相关的因素包括菌血症前ICU住院时间较短（P = 0.005）、慢性肾衰竭病史比例较低（P = 0.034）、癌症（P = 0.042）或移植（P = 0.025）、3个月内碳青霉烯类药物暴露频率较低（P = 0.015）。接受LAT治疗的存活患者组中脓毒性休克（P = 0.017）或肺炎继发菌血症（P = 0.003）的比例较高。调整后，两组间生存率无差异（HR：1.65，95%CI：0.91 - 3.00，P = 0.10）。
在我们的队列中，ICU获得性ESBL-E菌血症且存活超过7天的患者中有四分之一接受了SAT治疗。SAT似乎不影响生存率。需要更好地识别可能从SAT治疗中获益的患者。
