Incidence and impact on clinical outcome of infections with piperacillin/tazobactam resistant Escherichia coli in ICU : a retrospective study.
Escherichia coli infections are frequent in ICU patients. The increased resistance to fluoroquinolones and amoxicillin/clavulanate of this pathogen mandates the prescription of broad-spectrum antibiotics such as piperacillin/tazobactam (PIP-TAZ) or third generation cephalosporins (3GC).
Methods: To assess incidence and impact on clinical outcome of infections with PIP-TAZ resistant E.
coli in ICU patients, we conducted a retrospective cohort study with infections due to PIP-TAZ resistant (PIP-TAZ R) or to PIP-TAZ susceptible strains (PIP-TAZ S) between 1 January 2002 and 30 June 2004.
Results: Of 83 strains, 13 were PIP-TAZ R : 2 strains produced an extended-spectrum beta-lactamase (2%), 11 produced a high level penicillinase (13%). Prior amoxicillin or amoxicillin/clavulanate prescription was reported in 7 cases (54%) of infections with PIP-TAZ R isolates and in 15 cases (21%) of infections with PIP-TAZ S isolates (p=0.03).
Time of onset of the infection from hospital admission was longer in case of infections with PIP-TAZ R than with PIP-TAZ S isolates ( 22 +/- 32 vs 10 +/- 21 days, p=0.01). The overall ICU mortality rate was 38%.
Mortality and length of stay in ICU were similar in case of infections with PIP-TAZ R isolates and with PIP-TAZ S isolates.
Conclusion: Infections with PIP-TAZ R E. coli are frequent in ICU patients.
No prognostic impact of this pattern of resistance was found. Prescription of PIP-TAZ for empirical treatment of E.
coli infections in ICU however exposes to inappropriate therapy.
Author: Agnes Meybeck, Jean-Damien Ricard, Guilene Barnaud, Mathieu Eveillard, Guillaume Chevrel, Roman Mounier and Didier Dreyfuss
Credits/Source: BMC Infectious Diseases 2008, 8:67
Published on: 2008-05-17
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