Gram-negative bacteremia: which empirical antibiotic therapy?
M Shoai Tehrani1, D Hajage2, V Fihman3
1Équipe Mobile d'infectiologie, Service de Maladies Infectieuses, CHU Necker-Enfants-Malades, AP-HP, Paris, France.
Medecine Et Maladies Infectieuses
|March 26, 2014
Summary
Third-generation cephalosporins may no longer be suitable for community-acquired Gram-negative bacteremia due to rising cefotaxime resistance. Local data is crucial before altering empirical antibiotic therapy guidelines.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pharmacology
Background:
- Increasing prevalence of cefotaxime-resistant Gram-negative bacteria challenges empirical antibiotic choices.
- Third-generation cephalosporins (3GC) are commonly used for community-acquired Gram-negative bacteremia (CA-GNB).
Purpose of the Study:
- To assess the frequency of cefotaxime-resistant strains in CA-GNB.
- To identify factors predicting cefotaxime resistance in CA-GNB.
- To inform empirical antibiotic therapy recommendations.
Main Methods:
- Multicenter prospective descriptive study.
- Inclusion of patients diagnosed with CA-GNB.
- Analysis of bacterial species, resistance patterns, and clinical variables.
Main Results:
- Cefotaxime resistance was observed in 18% of CA-GNB cases, primarily due to intrinsic resistance.
- Escherichia coli and Pseudomonas aeruginosa were the most common pathogens.
- Invasive material, patient origin (Paris region/West France), and home health care predicted resistance.
Conclusions:
- Cefotaxime-resistant strains are a significant concern in CA-GNB, with limited involvement of ESBL-producing Enterobacteriaceae.
- Local epidemiological data are essential for guiding empirical antibiotic therapy decisions.
- Current 3GC use for CA-GNB requires careful consideration of local resistance patterns.
Keywords:
Bactériémie à Gram négatifBêta-lactamase à spectre étenduCefotaxime-resistanceExtended-spectrum b-lactamaseGram-negative bacteremiaHealth care-associated infectionRésistance au céfotaximeMore Related Videos
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