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Updated: Feb 11, 2026

Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex

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Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum

François Barbier1, Sébastien Bailly2, Carole Schwebel3

  • 1Medical ICU, La Source Hospital, CHR Orléans, Orléans, France.

Intensive Care Medicine
|April 18, 2018
PubMed
Abstract

Insights

Infection-related ventilator-associated complications (IVAC) in extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE) carriers often stem from non-infectious causes, yet significantly increase carbapenem use. Predicting rare ESBLE infections requires better diagnostics and carbapenem-sparing strategies.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Antimicrobial Stewardship

Background:

  • Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE) colonization is a concern in intensive care units.
  • Mechanically ventilated (MV) patients are at risk for ventilator-associated complications (VAC).
  • Understanding the drivers of antimicrobial consumption is crucial for stewardship.

Purpose of the Study:

  • To determine the clinical significance of infection-related ventilator-associated complications (IVAC).
  • To assess the impact of IVAC on carbapenem consumption in ESBLE-colonized, MV patients.
  • To differentiate between infectious and non-infectious causes of IVAC in this population.

Main Methods:

  • Prospective inception cohort study (OUTCOMEREA database, 1997-2015).
  • Inclusion of ESBLE carriers with MV > 48h and at least one IVAC episode.
  • Microbiological documentation of all ICU-acquired infections.

Main Results:

  • 318 ESBLE carriers experienced 576 IVAC episodes; 63% were without documented infection.
  • ESBLE infections accounted for only 7% of IVAC episodes.
  • Prior carbapenem exposure was the sole predictor of ESBLE infection (protective effect).
  • Carbapenem initiation increased with IVAC severity, from 9% (no infection) to 56% (ESBLE VAP).

Conclusions:

  • IVAC in ESBLE carriers are frequently non-infectious but drive empirical carbapenem use.
  • ESBLE infections are uncommon but difficult to predict.
  • Novel diagnostic tools and carbapenem-sparing strategies are needed for ESBLE carriers.
Keywords:
CarbapenemExtended-spectrum beta-lactamaseMechanical ventilationOutcomeVentilator-associated pneumonia

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