Clinical outcome of wild-type AmpC-producing Enterobacterales infection in critically ill patients treated with β-lactams: a prospective multicenter study

Mounier, Roman; Le Guen, Ronan; Woerther, Paul-Louis; Nacher, Mathieu; Bonnefon, Clément; Mongardon, Nicolas; Langeron, Olivier; Levesque, Eric; Couffin, Séverine; Houcke, Stéphanie; Wolff, Michel; Roujansky, Ariane; Schimpf, Caroline; Mekontso Dessap, Armand; Cook, Fabrice; Razazi, Keyvan; Kallel, Hatem

doi:10.1186/s13613-022-01079-5

Annals of Intensive Care

Table 4 Microorganisms responsible for infections and antimicrobial therapy

From: Clinical outcome of wild-type AmpC-producing Enterobacterales infection in critically ill patients treated with β-lactams: a prospective multicenter study

	All population (n = 177)		Clinical failure (n = 52)		Clinical success (n = 125)		p
	Nb	Results	Nb	Results	Nb	Results	p
Monomicrobial infection	177	71 (40.1%)	52	24 (46.2%)	125	47 (37.6%)	0.29
E. cloacae	177	75 (42.4%)	52	18 (34.6%)	125	57 (45.6%)	0.178
K. aerogenes	177	32 (18.1%)	52	17 (32.7%)	125	15 (12%)	0.001
S. marcescens	177	43 (24.3%)	52	13 (25%)	125	30 (24%)	0.888
C. freundii	177	11 (6.2%)	52	2 (3.8%)	125	9 (7.2%)	0.4
M. morganii	177	16 (9%)	52	1 (1.9%)	125	15 (12%)	0.003
H. alvei	177	14 (7.9%)	52	5 (9.6%)	125	9 (7.2%)	0.588
P. aeruginosa	177	19 (10.7%)	52	4 (7.7%)	125	15 (12%)	0.399
S. aureus	177	23 (13%)	52	4 (7.7%)	125	19 (15.2%)	0.176
Bacterial inoculum (cfu/mL)	113	10 [1–1, 000]	45	10⁴ [10³–775 × 10³]	91	5 × 10⁴ [10³–10⁶]	0.261
Empirical therapy	177	177 (100%)	52	52 (100%)	125	125 (100%)
Combination therapy	177	166 (93.8%)	47	12 (25.5%)	119	30 (25.2%)	0.966
Strains susceptible to the empirical AMB therapy	177	166 (93.8%)	52	47 (90.4%)	125	119 (95.2%)	0.227
wtAE susceptible to the β-lactam included in empirical therapy	177	163 (92.1%)	52	45 (86.5%)	125	118 (94.4%)	0.078
Duration of empirical antimicrobial therapy (days)	103	2 [2, 3]	33	2 [1–3]	70	2 [2, 3]	0.188
Cefotaxime	177	31 (17.5%)	52	5 (9.6%)	125	26 (20.8%)	0.075
Piperacillin–tazobactam	177	55 (31.1%)	52	14 (26.9%)	125	41 (32.8%)	0.442
Cefepime	177	61 (34.5%)	52	19 (36.5%)	125	42 (33.6%)	0.708
Imipenem	177	8 (4.5%)	52	3 (5.8%)	125	5 (4%)	0.606
Meropenem	177	6 (3.4%)	52	3 (5.8%)	125	3 (2.4%)	0.259
Carbapenem	177	14 (7.9%)	52	6 (11.5%)	125	8 (6.4%)	0.249
Amikacin	177	42 (23.7%)	52	12 (23.1%)	125	30 (24%)	0.895
Definitive antimicrobial therapy
Duration of antimicrobial therapy (days)	169	7 [6–10]	51	7 [6–9]	118	7 [7–11]	0.11
Piperacillin	177	18 (10.2%)	52	5 (9.6%)	125	13 (10.4%)	0.875
Cefotaxime	177	49 (27.7%)	52	8 (15.4%)	125	41 (32.8%)	0.018
Piperacillin–tazobactam	177	21 (11.9%)	52	6 (11.5%)	125	15 (12%)	0.931
Cefepime	177	76 (42.9%)	52	27 (51.9%)	125	49 (39.2%)	0.119
Imipenem	177	3 (1.7%)	52	2 (3.8%)	125	1 (0.8%)	0.153
Meropenem	177	10 (5.6%)	52	4 (7.7%)	125	6 (4.8%)	0.448
Carbapenem	177	13 (7.3%)	52	6 (11.5%)	125	7 (5.6%)	0.168

Bacterial inoculum concerns only samples collected by telescopic catheters protected in ventilator-associated pneumonia. Combination therapy means the combination of two antibiotics active in vivo, on the wild-type AmpC-producing Enterobacterales. Regarding empirical therapy, the susceptibility of strains to empirical antimicrobial therapy concerns all strains found in the sample, whether they are wtAE or not
AMB: antimicrobial; wtAE: wild-type AmpC-producing Enterobacterales; Nb: number of available values for the data

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