Antibiotic Susceptibility in Aerobic Gram-negative Bacilli Isolated in Intensive Care Units in 39 French Teaching Hospitals (ICU Study)

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 1996 Oct 1

PMID 8923070

Citations 9

Authors

V Jarlier

T Fosse

A Philippon

Affiliations

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Abstract

Objective: Evaluation of the distribution and antibiotic susceptibility of the aerobic gram-negative bacilli (AGNB) isolated from patients in intensive care units (ICU study).

Design And Setting: Microbiological study carried out in 1991 in 39 teaching hospitals. A standardized method was used to determine the minimum inhibitory concentrations of 12 antibiotics against 3366 strains of AGNB (close to 100 strains per hospital) during a period of 3 months.

Results: The 2773 initial strains (i.e., the first AGNB isolate for a given species and a given patient) were mainly isolated from the respiratory tract (34.4%), urinary tract (23%), or blood (9.6%) and were mainly Pseudomonas aeruginosa (22.9%), Escherichia coli (22%), Acinetobacter (9.7%), and Klebsiella pneumoniae (8.3%). E. coli was prominent in urine and blood and P. aeruginosa in the respiratory tract. Overall, the rate of susceptibility of AGNB was 58 to 65% to piperacillin, cefotaxime, and gentamicin; 69 to 75% to aztreonam, tobramycin, and ciprofloxacin; 83% to ceftazidime; and 91% to imipenem. The overall rates of susceptibility were higher for the initial strains isolated from blood than for those from the urinary or respiratory tracts, mostly reflecting differences in species distribution. Susceptibility rates were lower for the 593 repeat strains (i.e., all the subsequent isolates for a given species and a given patient) than for the initial strains, mostly due to the higher proportion of resistant species (P. aeruginosa 45.9%) but also due to the difference in susceptibility rates for some species-antibiotic combinations. Concomitant resistance (i.e., resistance to several antibiotics due to independent mechanisms of resistance) was marked between beta-lactams and aminoglycosides or quinolones, particularly in P. aeruginosa and K. pneumoniae.

Conclusions: Rates of resistance in AGNB as a whole and in particular species (P. aeruginosa, Klebsiella), as well as frequency of concomitant resistance found in the French ICU study, were higher than those found in ICU studies conducted with the same methodology in Belgium, The Netherlands, and Germany, which may reflect differences in case mix.

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References

Verbist L . Incidence of multi-resistance in gram-negative bacterial isolates from intensive care units in Belgium: a surveillance study. Scand J Infect Dis Suppl. 1991; 78:45-53. View

Goldstein F, Pean Y, Rosato A, Gertner J, Gutmann L . Characterization of ceftriaxone-resistant Enterobacteriaceae: a multicentre study in 26 French hospitals. Vigil'Roc Study Group. J Antimicrob Chemother. 1993; 32(4):595-603. DOI: 10.1093/jac/32.4.595. View

Cambau E, Perani E, Dib C, Petinon C, Trias J, Jarlier V . Role of mutations in DNA gyrase genes in ciprofloxacin resistance of Pseudomonas aeruginosa susceptible or resistant to imipenem. Antimicrob Agents Chemother. 1995; 39(10):2248-52. PMC: 162924. DOI: 10.1128/AAC.39.10.2248. View

Snydman D . Clinical implications of multi-drug resistance in the intensive care unit. Scand J Infect Dis Suppl. 1991; 78:54-63. View

Jarlier V, Bismuth R, Nicolas M, Nguyen J, Truffot C, Grosset J . Survey of the phenotypes of susceptibility to beta-lactams in Enterobacteriaceae at the Pitie-Salpetriere Hospital. J Antimicrob Chemother. 1984; 14 Suppl B:59-65. DOI: 10.1093/jac/14.suppl_b.59. View

Sirot D, Goldstein F, Soussy C, Courtieu A, Husson M, LEMOZY J . Resistance to cefotaxime and seven other beta-lactams in members of the family Enterobacteriaceae: a 3-year survey in France. Antimicrob Agents Chemother. 1992; 36(8):1677-81. PMC: 192029. DOI: 10.1128/AAC.36.8.1677. View

Rouby J, Rossignon M, Nicolas M, Martin de Lassale E, Cristin S, Grosset J . A prospective study of protected bronchoalveolar lavage in the diagnosis of nosocomial pneumonia. Anesthesiology. 1989; 71(5):679-85. DOI: 10.1097/00000542-198911000-00010. View

Vincent J, Bihari D, Suter P, Bruining H, White J, Wolff M . The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995; 274(8):639-44. View

Schaberg D, Culver D, Gaynes R . Major trends in the microbial etiology of nosocomial infection. Am J Med. 1991; 91(3B):72S-75S. DOI: 10.1016/0002-9343(91)90346-y. View

10.

Bure A, Legrand P, Arlet G, Jarlier V, Paul G, Philippon A . Dissemination in five French hospitals of Klebsiella pneumoniae serotype K25 harbouring a new transferable enzymatic resistance to third generation cephalosporins and aztreonam. Eur J Clin Microbiol Infect Dis. 1988; 7(6):780-2. DOI: 10.1007/BF01975048. View

11.

Geerdes H, Ziegler D, Lode H, Hund M, Loehr A, Fangmann W . Septicemia in 980 patients at a university hospital in Berlin: prospective studies during 4 selected years between 1979 and 1989. Clin Infect Dis. 1992; 15(6):991-1002. DOI: 10.1093/clind/15.6.991. View

12.

Dib C, Trias J, Jarlier V . Lack of additive effect between mechanisms of resistance to carbapenems and other beta-lactam agents in Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis. 1995; 14(11):979-86. DOI: 10.1007/BF01691380. View

13.

Sanders C, Sanders Jr W . Emergence of resistance during therapy with the newer beta-lactam antibiotics: role of inducible beta-lactamases and implications for the future. Rev Infect Dis. 1983; 5(4):639-48. DOI: 10.1093/clinids/5.4.639. View

14.

Sirot D, Sirot J, Labia R, Morand A, Courvalin P, Darfeuille-Michaud A . Transferable resistance to third-generation cephalosporins in clinical isolates of Klebsiella pneumoniae: identification of CTX-1, a novel beta-lactamase. J Antimicrob Chemother. 1987; 20(3):323-34. DOI: 10.1093/jac/20.3.323. View

15.

Vallee E, Bergogne-Berezin E, Philippon A . Distribution of beta-lactamases and phenotype analysis in clinical strains of Acinetobacter calcoaceticus. J Antimicrob Chemother. 1988; 22(5):597-604. DOI: 10.1093/jac/22.5.597. View

16.

Kreger B, Craven D, Carling P, McCabe W . Gram-negative bacteremia. III. Reassessment of etiology, epidemiology and ecology in 612 patients. Am J Med. 1980; 68(3):332-43. DOI: 10.1016/0002-9343(80)90101-1. View

17.

McGowan Jr J, Hall E, Parrott P . Antimicrobial susceptibility in gram-negative bacteremia: are nosocomial isolates really more resistant?. Antimicrob Agents Chemother. 1989; 33(11):1855-9. PMC: 172776. DOI: 10.1128/AAC.33.11.1855. View

18.

Brun-Buisson C, Legrand P, Philippon A, Montravers F, Ansquer M, Duval J . Transferable enzymatic resistance to third-generation cephalosporins during nosocomial outbreak of multiresistant Klebsiella pneumoniae. Lancet. 1987; 2(8554):302-6. DOI: 10.1016/s0140-6736(87)90891-9. View

19.

Sugarman B, Pesanti E . Treatment failures secondary to in vivo development of drug resistance by microorganisms. Rev Infect Dis. 1980; 2(2):153-68. DOI: 10.1093/clinids/2.2.153. View

20.

Milatovic D, Braveny I . Development of resistance during antibiotic therapy. Eur J Clin Microbiol. 1987; 6(3):234-44. DOI: 10.1007/BF02017607. View