Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care - An analysis of the OUTCOMEREA database

Morvan, A.-C.; Hengy, B.; Garrouste-Orgeas, M.; Ruckly, S.; Forel, J.-M.; Argaud, L.; Rimmelé, T.; Bedos, J.-P.; Azoulay, E.; Dupuis, C.; Mourvillier, B.; Schwebel, C.; Timsit, J.-F.; Zahar, J.-R.; Darmon, M.; Clec'H, C.; Alberti, C.; Bailly, S.; Vannieuwenhuyze, A.; Hernu, R.; Adrie, C.; Agasse, C.; Allaouchiche, B.; Andremont, O.; Andreu, P.; Ara-Somohano, C.; Barbier, F.; Boyer, D.; Baudry, T.; Bedel, J.; Bohé, J.; Bouadma, L.; Bourenne, J.; Brule, N.; Brétonnière, C.; Chemouni, F.; Cheval, C.; Carvelli, J.; Coupez, E.; Cour, M.; De Montmollin, E.; Dopeux, L.; Dumenil, A.-S.; Forel, J.-M.; Gainnier, M.; Garret, C.; Goldgran-Tonedano, D.; Grangé, S.; Gros, A.; Hammed, H.; Haouache, A.; Hissem, T.; Ha, V. H. T.; Jochmans, S.; Joffredo, J.-B.; Kallel, H.; Lacave, G.; Laurent, V.; Lautrette, A.; Magalhaes, C. L. B. E.; Lemiale, V.; Marcotte, G.; Lebut, J.; Lugosi, M.; Merceron, S.; Misset, Benoît; Neuville, M.; Nicolet, L.; Oziel, J.; Papazian, L.; Patrier, J.; Planquette, B.; Radjou, A.; Simon, M.; Sonneville, R.; Reignier, J.; Souweine, B.; Siami, S.; Terzi, N.; Troché, G.; Thuong, M.; Thierry, G.; Venot, M.; Yaacoubi, S.; Zambon, O.; Fournier, J.; Bagur, S.; Adda, M.; Vindrieux, V.; De La Salle, S.; Enguerrand, P.; Gobert, V.; Guessens, S.; Merle, H.; Kaddour, N.; Berthe, B.; Bekkhouche, S.; Mellouk, K.; Lebrazic, M.; Ouisse, C.; Maugars, D.; Aparicio, C.; Theodose, I.; Nouacer, M.; Deiler, V.; Lamara, F.; Moussa, M.; Mouaci, A.; Viguier, N.

doi:10.1186/s13054-019-2581-8

Article (Scientific journals)

Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care - An analysis of the OUTCOMEREA database

Morvan, A.-C.; Hengy, B.; Garrouste-Orgeas, M. et al.

2019 • In Critical Care, 23 (1)

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/245107

DOI
10.1186/s13054-019-2581-8

PubMed
31492201

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Keywords :

Antibiotic therapy; Enterococcus spp.; Intensive care; Intraabdominal infections; Mortality

Abstract :

[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. © 2019 The Author(s).

Disciplines :

Anesthesia & intensive care

Author, co-author :

Morvan, A.-C.; Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Teaching Hospital, 5 place d'Arsonval, Lyon, 69003, France

Hengy, B.; Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Teaching Hospital, 5 place d'Arsonval, Lyon, 69003, France

Garrouste-Orgeas, M.; Polyvalent ICU, St Joseph Hospital, Paris, France

Ruckly, S.; UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care, INSERM Paris, Diderot University, Sorbonne Paris Cité, Paris, France

Forel, J.-M.; Medical ICU, Respiratory Distress and Severe Infections, Nord Hospital, URMITE CNRS, UMR 6236, Aix-Marseille University, AP-HM, Marseille, France

Argaud, L.; Medical ICU, Hospices Civils de Lyon, Edouard Herriot Teaching Hospital, Lyon, France

Rimmelé, T.; Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Teaching Hospital, 5 place d'Arsonval, Lyon, 69003, France

Bedos, J.-P.; Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles, Site André Mignot, Le Chesnay, Cedex, France

Azoulay, E.; Medical ICU, APHP, Saint-Louis Hospital, ECSTRA Team, Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris, France

Dupuis, C.

More authors (99 more)

Language :

English

Title :

Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care - An analysis of the OUTCOMEREA database

Publication date :

2019

Journal title :

Critical Care

ISSN :

1364-8535

eISSN :

1466-609X

Publisher :

BioMed Central Ltd.

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Issue :

Peer reviewed :

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