1
|
Kherabi Y, Michoud C, Villageois-Tran K, Bert F, Pioche M, Lefort A, Lévy P, Rebours V, Zarrouk V. Epidemiology, treatment and outcomes of infected pancreatic necrosis in France: a bicenter study. Infect Dis Now 2024; 54:104866. [PMID: 38367772 DOI: 10.1016/j.idnow.2024.104866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Acute necrotizing pancreatitis (ANP) mortality increases when pancreatic necrosis is infected (IPN). Current treatment of IPN relies on prolonged antibiotic therapies associated with a step-up strategy of drainage. The objective of this study was to analyze IPN treatment outcomes in two referral centers in France. METHODS Data of consecutive patients with documented IPN hospitalized in two expert centers in France between 2014 and 2019 were retrospectively reviewed. The composite primary outcome was the proportion of unsuccessful management outcome, defined as new emergency drainage to treat sepsis with organ failure, an unplanned new antibiotic course, an unplanned prolongation of antibiotic course and/or death by septic shock, within three months following the diagnosis of ANP. RESULTS All in all, 187 patients (138 males; 74.0%), with documented IPN were included. The most frequently identified microorganism was Escherichia coli (26.2%). Ninety-eight patients (52.4%) were admitted to an intensive care unit or resuscitation ward within the first two days of ANP care. Overall, 126 patients (67.4%) endured an unsuccessful outcome: new emergency drainage to treat acute sepsis (62.0%), unplanned new antibiotic course (47.1%), unplanned prolongation of antibiotic course (44.9%) and/or death by septic shock complicating IPN (8.0%). CONCLUSION The unfavorable evolution in two thirds of patients shows that determination of optimal drainage timing and choice of antibiotic therapy remain major challenges in 2024.
Collapse
Affiliation(s)
- Yousra Kherabi
- Internal Medicine Department, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France.
| | - Claire Michoud
- Gastroenterology Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, France
| | - Khanh Villageois-Tran
- Microbiology Department, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France
| | - Frédéric Bert
- Microbiology Department, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France
| | - Mathieu Pioche
- Gastroenterology Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, France
| | - Agnès Lefort
- Internal Medicine Department, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France
| | - Philippe Lévy
- Pancreatology Department, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France
| | - Vinciane Rebours
- Pancreatology Department, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France
| | - Virginie Zarrouk
- Internal Medicine Department, AP-HP.Nord, Hôpital Beaujon, Université Paris Cité, Clichy, France
| |
Collapse
|
2
|
Patrier J, Villageois-Tran K, Szychowiak P, Ruckly S, Gschwind R, Wicky PH, Gueye S, Armand-Lefevre L, Marzouk M, Sonneville R, Bouadma L, Petitjean M, Lamara F, de Montmollin E, Timsit JF, Ruppé E. Oropharyngeal and intestinal concentrations of opportunistic pathogens are independently associated with death of SARS-CoV-2 critically ill adults. Crit Care 2022; 26:300. [PMID: 36192756 PMCID: PMC9527714 DOI: 10.1186/s13054-022-04164-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The composition of the digestive microbiota may be associated with outcome and infections in patients admitted to the intensive care unit (ICU). The dominance by opportunistic pathogens (such as Enterococcus) has been associated with death. However, whether this association remains all throughout the hospitalization are lacking. METHODS We performed a single-center observational prospective cohort study in critically ill patients admitted with severe SARS-CoV-2 infection. Oropharyngeal and rectal swabs were collected at admission and then twice weekly until discharge or death. Quantitative cultures for opportunistic pathogens were performed on oropharyngeal and rectal swabs. The composition of the intestinal microbiota was assessed by 16S rDNA sequencing. Oropharyngeal and intestinal concentrations of opportunistic pathogens, intestinal richness and diversity were entered into a multivariable Cox model as time-dependent covariates. The primary outcome was death at day 90. RESULTS From March to September 2020, 95 patients (765 samples) were included. The Simplified Acute Physiology Score 2 (SAPS 2) at admission was 33 [24; 50] and a Sequential Organ Failure Assessment score (SOFA score) at 6 [4; 8]. Day 90 all-cause mortality was 44.2% (42/95). We observed that the oropharyngeal and rectal concentrations of Enterococcus spp., Staphylococcus aureus and Candida spp. were associated with a higher risk of death. This association remained significant after adjustment for prognostic covariates (age, chronic disease, daily antimicrobial agent use and daily SOFA score). A one-log increase in Enterococcus spp., S. aureus and Candida spp. in oropharyngeal or rectal swabs was associated with a 17% or greater increase in the risk of death. CONCLUSION We found that elevated oropharyngeal/intestinal Enterococcus spp. S. aureus and Candida spp. concentrations, assessed by culture, are associated with mortality, independent of age, organ failure, and antibiotic therapy, opening prospects for simple and inexpensive microbiota-based markers for the prognosis of critically ill SARS-CoV-2 patients.
Collapse
Affiliation(s)
- Juliette Patrier
- grid.411119.d0000 0000 8588 831XAP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France
| | - Khanh Villageois-Tran
- grid.411599.10000 0000 8595 4540AP-HP, Service de Microbiologie, Hôpital Beaujon, 75018 Paris, France ,grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, 75018 Paris, France
| | - Piotr Szychowiak
- grid.411119.d0000 0000 8588 831XAP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France ,grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, 75018 Paris, France
| | - Stéphane Ruckly
- grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, 75018 Paris, France ,grid.508487.60000 0004 7885 7602OUTCOME REA Research Network, IAME, INSERM, Université de Paris, 75018 Paris, France
| | - Rémi Gschwind
- grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, 75018 Paris, France
| | - Paul-Henri Wicky
- grid.411119.d0000 0000 8588 831XAP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France
| | - Signara Gueye
- grid.411119.d0000 0000 8588 831XAP-HP, Service de Bactériologie, Hôpital Bichat-Claude Bernard, 75018 Paris, France
| | - Laurence Armand-Lefevre
- grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, 75018 Paris, France ,grid.411119.d0000 0000 8588 831XAP-HP, Service de Bactériologie, Hôpital Bichat-Claude Bernard, 75018 Paris, France
| | - Mehdi Marzouk
- grid.411119.d0000 0000 8588 831XAP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France
| | - Romain Sonneville
- grid.411119.d0000 0000 8588 831XAP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France ,grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, 75018 Paris, France ,grid.508487.60000 0004 7885 7602OUTCOME REA Research Network, IAME, INSERM, Université de Paris, 75018 Paris, France
| | - Lila Bouadma
- grid.411119.d0000 0000 8588 831XAP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France ,grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, 75018 Paris, France ,grid.508487.60000 0004 7885 7602OUTCOME REA Research Network, IAME, INSERM, Université de Paris, 75018 Paris, France
| | - Marie Petitjean
- grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, 75018 Paris, France
| | - Fariza Lamara
- grid.411119.d0000 0000 8588 831XAP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France ,grid.508487.60000 0004 7885 7602OUTCOME REA Research Network, IAME, INSERM, Université de Paris, 75018 Paris, France
| | - Etienne de Montmollin
- grid.411119.d0000 0000 8588 831XAP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France ,grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, 75018 Paris, France ,grid.508487.60000 0004 7885 7602OUTCOME REA Research Network, IAME, INSERM, Université de Paris, 75018 Paris, France
| | - Jean-Francois Timsit
- grid.411119.d0000 0000 8588 831XAP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France ,grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, 75018 Paris, France ,grid.508487.60000 0004 7885 7602OUTCOME REA Research Network, IAME, INSERM, Université de Paris, 75018 Paris, France
| | - Etienne Ruppé
- grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, 75018 Paris, France ,grid.411119.d0000 0000 8588 831XAP-HP, Service de Bactériologie, Hôpital Bichat-Claude Bernard, 75018 Paris, France
| | | |
Collapse
|
3
|
Habib A, Lo S, Villageois-Tran K, Petitjean M, Malik SA, Armand-Lefèvre L, Ruppé E, Zahra R. Dissemination of carbapenemase-producing Enterobacterales in the community of Rawalpindi, Pakistan. PLoS One 2022; 17:e0270707. [PMID: 35802735 PMCID: PMC9269877 DOI: 10.1371/journal.pone.0270707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 06/15/2022] [Indexed: 11/18/2022] Open
Abstract
Carbapenems are considered last-line beta-lactams for the treatment of infections caused by multidrug-resistant Gram-negative bacteria. However, their activity is compromised by the rising prevalence of carbapenemase-producing Enterobacterales (CPE), which are especially marked in the Indian subcontinent. In Pakistan, previous reports have warned about the possible spread of CPE in the community, but data are still partial. This study was carried out to analyse the prevalence of CPE, the genetic characterisation, and phylogenetic links among the spreading CPE in the community. In this cohort study, we collected 306 rectal swabs from patients visiting Benazir Bhutto hospital, Rawalpindi. CPEs were screened by using ertapenem-supplemented MacConkey agar. Identification was performed by using conventional biochemical tests, and genomes were sequenced using Illumina chemistry. Antibiotic resistance genes, plasmid incompatibility groups, and Escherichia coli phylogroups were determined in silico. Sequence types were determined by using MLST tool. The prevalence of CPE carriage observed was 14.4% (44/306 samples). The most common carbapenemase-encoding gene was bla-NDM-5 (n = 58) followed by blaNDM-1 (n = 7), blaNDM (non-assigned variant, n = 4), blaOXA-181 (n = 3), blaOXA-232 (n = 3) and blaNDM-7 (n = 1). Most of the CPE were E. coli (55/64, 86%), and the genomic analysis revealed a pauciclonal diffusion of E. coli with ST167 (n = 14), 405 (n = 10), 940 (n = 8), 648 (n = 6) and 617 (n = 5). We obtained a second sample from 94 patients during their hospital stay in whom carriage was negative at admission and found that 7 (7.4%) acquired a CPE. Our results indicate that the prevalence of CPE carriage in the Pakistani urban community was high and driven by the dissemination of some E. coli clones, with ST167 being the most frequent. The high CPE carriage in the community poses a serious public health threat and calls for implementation of adequate preventive measures.
Collapse
Affiliation(s)
- Amina Habib
- Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Stéphane Lo
- Université de Paris, IAME, INSERM, Paris, France
- APHP, Laboratoire de Bactériologie, Hôpital Bichat, Paris, France
| | - Khanh Villageois-Tran
- Université de Paris, IAME, INSERM, Paris, France
- APHP, Laboratoire de Bactériologie, Hôpital Beaujon, Clichy, France
| | | | - Shaheen Akhtar Malik
- Accident and Emergency Department, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Laurence Armand-Lefèvre
- Université de Paris, IAME, INSERM, Paris, France
- APHP, Laboratoire de Bactériologie, Hôpital Bichat, Paris, France
| | - Etienne Ruppé
- Université de Paris, IAME, INSERM, Paris, France
- APHP, Laboratoire de Bactériologie, Hôpital Bichat, Paris, France
| | - Rabaab Zahra
- Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
- * E-mail:
| |
Collapse
|
4
|
Szychowiak P, Villageois-Tran K, Patrier J, Timsit JF, Ruppé É. The role of the microbiota in the management of intensive care patients. Ann Intensive Care 2022; 12:3. [PMID: 34985651 PMCID: PMC8728486 DOI: 10.1186/s13613-021-00976-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022] Open
Abstract
The composition of the gut microbiota is highly dynamic and changes according to various conditions. The gut microbiota mainly includes difficult-to-cultivate anaerobic bacteria, hence knowledge about its composition has significantly arisen from culture-independent methods based on next-generation sequencing (NGS) such as 16S profiling and shotgun metagenomics. The gut microbiota of patients hospitalized in intensive care units (ICU) undergoes many alterations because of critical illness, antibiotics, and other ICU-specific medications. It is then characterized by lower richness and diversity, and dominated by opportunistic pathogens such as Clostridioides difficile and multidrug-resistant bacteria. These alterations are associated with an increased risk of infectious complications or death. Specifically, at the time of writing, it appears possible to identify distinct microbiota patterns associated with severity or infectivity in COVID-19 patients, paving the way for the potential use of dysbiosis markers to predict patient outcomes. Correcting the microbiota disturbances to avoid their consequences is now possible. Fecal microbiota transplantation is recommended in recurrent C. difficile infections and microbiota-protecting treatments such as antibiotic inactivators are currently being developed. The growing interest in the microbiota and microbiota-associated therapies suggests that the control of the dysbiosis could be a key factor in the management of critically ill patients. The present narrative review aims to provide a synthetic overview of microbiota, from healthy individuals to critically ill patients. After an introduction to the different techniques used for studying the microbiota, we review the determinants involved in the alteration of the microbiota in ICU patients and the latter's consequences. Last, we assess the means to prevent or correct microbiota alteration.
Collapse
Affiliation(s)
- Piotr Szychowiak
- Université de Paris, IAME, INSERM, 75018, Paris, France
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional Universitaire de Tours, 37000, Tours, France
| | - Khanh Villageois-Tran
- Université de Paris, IAME, INSERM, 75018, Paris, France
- Laboratoire de Bactériologie, AP-HP, Hôpital Beaujon, 92110, Paris, France
| | - Juliette Patrier
- Université de Paris, IAME, INSERM, 75018, Paris, France
- Service de Réanimation Médicale Et Infectieuse, AP-HP, Hôpital Bichat, 75018, Paris, France
| | - Jean-François Timsit
- Université de Paris, IAME, INSERM, 75018, Paris, France
- Service de Réanimation Médicale Et Infectieuse, AP-HP, Hôpital Bichat, 75018, Paris, France
| | - Étienne Ruppé
- Université de Paris, IAME, INSERM, 75018, Paris, France.
- Laboratoire de Bactériologie, AP-HP, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France.
| |
Collapse
|