Predictive Value of Prior Colonization and Antibiotic Use for Third-Generation Cephalosporin-Resistant Enterobacteriaceae Bacteremia in Patients With Sepsis
Open accessAbstract
BACKGROUND: To prevent inappropriate empiric antibiotic treatment in patients with bacteremia caused by third-generation cephalosporin (3GC)-resistant Enterobacteriaceae (3GC-R EB), Dutch guidelines recommend β-lactam and aminoglycoside combination therapy or carbapenem monotherapy in patients with prior 3GC-R EB colonization and/or recent cephalosporin or fluoroquinolone usage. Positive predictive values (PPVs) of these determinants are unknown. METHODS: We retrospectively studied patients with a clinical infection in whom blood cultures were obtained and empiric therapy with broad-spectrum β-lactams and/or aminoglycosides and/or fluoroquinolones was started. We determined the PPVs of prior colonization and antibiotic use for 3GC-R EB bacteremia, and the consequences of guideline adherence on appropriateness of empiric treatment. RESULTS: Of 9422 episodes, 773 (8.2%) were EB bacteremias and 64 (0.7%) were caused by 3GC-R EB. For bacteremia caused by 3GC-R EB, PPVs of prior colonization with 3GC-R EB (90-day window) and prior usage of cephalosporins or fluoroquinolones (30-day window) were 7.4% and 1.3%, respectively, and PPV was 1.8% for the presence of any of these predictors. Adherence to Dutch sepsis guideline recommendations was 27%. Of bacteremia episodes caused by 3GC-R and 3GC-sensitive EB, 56% and 94%, respectively, were initially treated with appropriate antibiotics. Full adherence to guideline recommendations would hardly augment proportions of appropriate therapy, but could considerably increase carbapenem use. CONCLUSIONS: In patients receiving empiric treatment for sepsis, prior colonization with 3GC-R EB and prior antibiotic use have low PPV for infections caused by 3GC-R EB. Strict guideline adherence would unnecessarily stimulate broad-spectrum antibiotic use.
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Factors guiding double gram-negative coverage include proven infection or colonisation with resistant organisms in the prior year, local prevalence, hospital-acquired/healthcare-associated infection, broad-spectrum antibiotics in prior 90 days, concurrent SDD, travel to a highly endemic country in prior 90 days, and hospitalisation abroad in prior 90 days.
“Factors to guide this decision include: proven infection or colonisation with antibiotic-resistant organisms within the preceding year, local prevalence of antibiotic-resistant organisms, hospital-acquired/healthcare associated (versus community-acquired infection), broad-spectrum antibiotic use within the preceding 90 days”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [163]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
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Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
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Rottier, W. C., van Werkhoven, C. H., Bamberg, Y. R. P., Dorigo-Zetsma, J. W., van de Garde, E. M., van Hees, B. C., Kluytmans, J. A. J. W., Kuck, E. M., van der Linden, P. D., Prins, J. M., et al. (2018) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2018.03.023 · Cited by 22 · see citing works
Self-citation
- Authors
- Rottier, W. C., Bamberg, Y. R. P., Dorigo-Zetsma, J. W., van der Linden, P. D., Ammerlaan, H. S. M., & Bonten, M. J. M.
- Affiliations
- University Medical Center Utrecht (NL)
- Corresponding author
- Rottier, Wouter C.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-02-18
- Volume
- 60
- Issue
- 11
- Pages
- 1622-1630
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2114604259
- Cited by
- 61
- References
- 27
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 3 · 2023: 7 · 2022: 7 · 2021: 10 · 2020: 5 · 2019: 9 · 2018: 6 · 2017: 3 · 2016: 3 · 2015: 2
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- green
- dspace.library.uu.nl
- Licence
- other-oa
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Funders
- Microsoft
- bioMérieux
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- bacteremia, sepsis, prior antibiotic use, positive predictive value, empirical antibiotic therapy, guideline adherence, carbapenem use, fluoroquinolone use
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Cephalosporins, Drug Utilization, Enterobacteriaceae, Enterobacteriaceae Infections, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Netherlands, Predictive Value of Tests, Retrospective Studies, beta-Lactam Resistance, Sepsis, Guideline Adherence, Young Adult
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