Semi-quantitative cultures of throat and rectal swabs are efficient tests to predict ESBL-Enterobacterales ventilator-associated pneumonia in mechanically ventilated ESBL carriers.

Content Provider	Europe PMC
Author	Andremont, Olivier Armand-Lefevre, Laurence Dupuis, Claire de Montmollin, Etienne Ruckly, Stéphane Lucet, Jean-Christophe Smonig, Roland Magalhaes, Eric Ruppé, Etienne Mourvillier, Bruno Lebut, Jordane Lermuzeaux, Mathilde Sonneville, Romain Bouadma, Lila Timsit, Jean-François
Abstract	PurposeIn ICU patients with carriage of extended spectrum beta-lactamase producing Enterobacterales (ESBL-E) and suspected Gram-negative bacilli ventilator-associated pneumonia (GNB-VAP), the quantification of the rectal and throat ESBL-E carriage might predict the ESBL-E involvement in GNB-VAP. Our aim was to evaluate whether a semi-quantitative assessment of rectal/throat ESBL-E carriage can predict ESBL-E-associated VAP in medical ICU patients.MethodsFrom May 2014 to May 2017, all ESBL-E carriers had a semi-quantitative assessment of ESBL-E density in swabs cultures. For those who developed GNB-VAP (diagnosed using bronchoalveolar lavage or plugged telescopic catheter with significant quantitative culture), the last positive swab collected at least 48 h before GNB-VAP onset was selected. Clinical data were extracted from a prospectively collected database.ResultsAmong 365 ESBL-E carriers, 82 developed 107 episodes of GNB-VAP (ESBL-E VAP, n = 50; and non-ESBL-E GNB-VAP, n = 57) after 13 days of mechanical ventilation in median. Antimicrobials use before VAP onset was similar between groups. The last swabs were collected 5 days in median before VAP onset. ESBL-E. coli carriers developed ESBL-E VAP less frequently (n = 13, 34%) than others (n = 32, 67.3%, p < .01). Throat swab positivity (39 (78%) vs. 12 (23%), p < .01) was more frequent for ESBL-E VAP. ESBL-E VAP was associated with significantly higher ESBL-E density in rectal swabs. In multivariate models, non-E. coli ESBL-E carriage and rectal ESBL-E carriage density, or throat carriage, remained associated with ESBL-E VAP.ConclusionIn carriers of ESBL-E other than E. coli, ESBL-E throat carriage or a high-density ESBL-E rectal carriage are risk factors of ESBL-E VAP in case of GNB-VAP.Electronic supplementary materialThe online version of this article (10.1007/s00134-020-06029-y) contains supplementary material, which is available to authorized users.
ISSN	03424642
Journal	Intensive Care Medicine
Volume Number	46
PubMed Central reference number	PMC7222166
Issue Number	6
PubMed reference number	32313993
e-ISSN	14321238
DOI	10.1007/s00134-020-06029-y
Language	English
Publisher	Springer Berlin Heidelberg
Publisher Date	2020-04-20
Publisher Place	Berlin/Heidelberg
Access Restriction	Open
Rights License	This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Subject Keyword	Extended-spectrum beta-lactamase E. coli Ventilator-associated pneumonia Sepsis Outcome Carbapenem
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine