Pierre Bay, Paul-Louis Woerther, Vincent Fihman, Ségolène Gendreau, Pascale Labedade, Antoine Gaillet, Florian Jolly, Guillaume Carteaux, Nicolas de Prost, Jean-Winoc Decousser, Armand Mekontso-Dessap, Keyvan Razazi
{"title":"通过粪便相对丰度预测与呼吸机相关肺炎有关的产扩展谱β-内酰胺酶肠杆菌。","authors":"Pierre Bay, Paul-Louis Woerther, Vincent Fihman, Ségolène Gendreau, Pascale Labedade, Antoine Gaillet, Florian Jolly, Guillaume Carteaux, Nicolas de Prost, Jean-Winoc Decousser, Armand Mekontso-Dessap, Keyvan Razazi","doi":"10.1186/s13613-025-01456-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial stewardship (AMS) for ventilator-associated pneumonia (VAP) in carriers of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) presents significant challenges. The abundance of ESBL-E rectal carriage has emerged as a potentially valuable tool for predicting ESBL-E-related VAP.</p><p><strong>Methods: </strong>This single-center, retrospective study was conducted between October 2019 and April 2023 in the medical ICU of a university hospital. The relative abundance of ESBL-E rectal carriage (RAC) was calculated as the ratio of ESBL-E counts to the total number of aerotolerant bacteria. The aim was to evaluate the predictive value of RAC for diagnosing ESBL-E-related VAP in patients with confirmed VAP who were ESBL-E carriers.</p><p><strong>Results: </strong>During the study period, 478 patients with ESBL-E carriage were admitted to the ICU, of whom 231 (48%) required mechanical ventilation. Eighty-three patients (17%) developed a total of 131 confirmed VAP episodes, of which 62 episodes (47%) were ESBL-E-related VAP. The median interval between the last rectal screening and VAP occurrence was 4 [3-7] days. RAC was not associated with ESBL-E-related VAP in the entire cohort (p = 0.39). Similar findings were observed in several sensitivity analyses, including the following subsets: recent and high-quality screening (interval between screening and VAP ≤ 7 days and bacterial load on rectal swab > 10<sup>4</sup> CFU/mL, p = 0.21); first VAP episodes only (p = 0.41); cases involving Escherichia coli exclusively (p = 0.08) or other ESBL-E strains (p = 0.29); and VAP associated with Gram-negative bacteria (p = 0.26) or Enterobacterales (p = 0.34). However, in a multivariable model, rectal colonization with non-Escherichia coli ESBL strains was independently associated with ESBL-E-related VAP (adjusted odds ratio [aOR] 1.213 [95% CI 1.005-1.463], p = 0.045).</p><p><strong>Conclusion: </strong>RAC was not associated with confirmed VAP in ESBL-E carriers. 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The abundance of ESBL-E rectal carriage has emerged as a potentially valuable tool for predicting ESBL-E-related VAP.</p><p><strong>Methods: </strong>This single-center, retrospective study was conducted between October 2019 and April 2023 in the medical ICU of a university hospital. The relative abundance of ESBL-E rectal carriage (RAC) was calculated as the ratio of ESBL-E counts to the total number of aerotolerant bacteria. The aim was to evaluate the predictive value of RAC for diagnosing ESBL-E-related VAP in patients with confirmed VAP who were ESBL-E carriers.</p><p><strong>Results: </strong>During the study period, 478 patients with ESBL-E carriage were admitted to the ICU, of whom 231 (48%) required mechanical ventilation. Eighty-three patients (17%) developed a total of 131 confirmed VAP episodes, of which 62 episodes (47%) were ESBL-E-related VAP. The median interval between the last rectal screening and VAP occurrence was 4 [3-7] days. RAC was not associated with ESBL-E-related VAP in the entire cohort (p = 0.39). Similar findings were observed in several sensitivity analyses, including the following subsets: recent and high-quality screening (interval between screening and VAP ≤ 7 days and bacterial load on rectal swab > 10<sup>4</sup> CFU/mL, p = 0.21); first VAP episodes only (p = 0.41); cases involving Escherichia coli exclusively (p = 0.08) or other ESBL-E strains (p = 0.29); and VAP associated with Gram-negative bacteria (p = 0.26) or Enterobacterales (p = 0.34). However, in a multivariable model, rectal colonization with non-Escherichia coli ESBL strains was independently associated with ESBL-E-related VAP (adjusted odds ratio [aOR] 1.213 [95% CI 1.005-1.463], p = 0.045).</p><p><strong>Conclusion: </strong>RAC was not associated with confirmed VAP in ESBL-E carriers. 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引用次数: 0
摘要
背景：广谱β-内酰胺酶产肠杆菌（ESBL-E）携带者呼吸机相关性肺炎（VAP）的抗菌管理（AMS）提出了重大挑战。ESBL-E直肠运载的丰度已成为预测ESBL-E相关VAP的潜在有价值的工具。方法：本研究于2019年10月至2023年4月在某大学附属医院内科ICU进行单中心回顾性研究。以ESBL-E计数与耐氧菌总数之比计算ESBL-E直肠运载菌（RAC）的相对丰度。目的是评估RAC在确诊为ESBL-E携带者的VAP患者中诊断ESBL-E相关VAP的预测价值。结果：研究期间，478例ESBL-E携带患者入住ICU，其中231例（48%）需要机械通气。83例患者（17%）共发生131次VAP，其中62次（47%）为esbl - e相关VAP。最后一次直肠筛查与VAP发生的中位间隔为4[3-7]天。在整个队列中，RAC与esbl - e相关VAP无关（p = 0.39）。在一些敏感性分析中观察到类似的结果，包括以下亚组：近期和高质量的筛查（筛查和VAP之间的间隔≤7天，直肠拭子细菌负荷> 104 CFU/mL, p = 0.21）；仅首次VAP发作（p = 0.41）；仅涉及大肠杆菌（p = 0.08）或其他ESBL-E菌株（p = 0.29）的病例；VAP与革兰氏阴性菌（p = 0.26）或肠杆菌（p = 0.34）相关。然而，在多变量模型中，非大肠杆菌ESBL菌株的直肠定植与ESBL- e相关VAP独立相关（调整优势比[aOR] 1.213 [95% CI 1.005-1.463], p = 0.045）。结论：RAC与ESBL-E携带者的VAP无相关性。需要进一步的研究来探索改善疑似VAP的ESBL-E携带者AMS的有效策略。
Relative faecal abundance to predict extended-spectrum β-lactamase-producing Enterobacterales related ventilator‑associated pneumonia.
Background: Antimicrobial stewardship (AMS) for ventilator-associated pneumonia (VAP) in carriers of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) presents significant challenges. The abundance of ESBL-E rectal carriage has emerged as a potentially valuable tool for predicting ESBL-E-related VAP.
Methods: This single-center, retrospective study was conducted between October 2019 and April 2023 in the medical ICU of a university hospital. The relative abundance of ESBL-E rectal carriage (RAC) was calculated as the ratio of ESBL-E counts to the total number of aerotolerant bacteria. The aim was to evaluate the predictive value of RAC for diagnosing ESBL-E-related VAP in patients with confirmed VAP who were ESBL-E carriers.
Results: During the study period, 478 patients with ESBL-E carriage were admitted to the ICU, of whom 231 (48%) required mechanical ventilation. Eighty-three patients (17%) developed a total of 131 confirmed VAP episodes, of which 62 episodes (47%) were ESBL-E-related VAP. The median interval between the last rectal screening and VAP occurrence was 4 [3-7] days. RAC was not associated with ESBL-E-related VAP in the entire cohort (p = 0.39). Similar findings were observed in several sensitivity analyses, including the following subsets: recent and high-quality screening (interval between screening and VAP ≤ 7 days and bacterial load on rectal swab > 104 CFU/mL, p = 0.21); first VAP episodes only (p = 0.41); cases involving Escherichia coli exclusively (p = 0.08) or other ESBL-E strains (p = 0.29); and VAP associated with Gram-negative bacteria (p = 0.26) or Enterobacterales (p = 0.34). However, in a multivariable model, rectal colonization with non-Escherichia coli ESBL strains was independently associated with ESBL-E-related VAP (adjusted odds ratio [aOR] 1.213 [95% CI 1.005-1.463], p = 0.045).
Conclusion: RAC was not associated with confirmed VAP in ESBL-E carriers. Further studies are needed to explore effective strategies for improving AMS in ESBL-E carriers with suspected VAP.
期刊介绍：
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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