Rothe, Kathrin;
Wantia, Nina;
Spinner, Christoph D.;
Schneider, Jochen;
Lahmer, Tobias;
Waschulzik, Birgit;
Schmid, Roland M.;
Busch, Dirk H.;
Katchanov, Juri
Antimicrobial resistance of bacteraemia in the emergency department of a German university hospital (2013–2018): potential carbapenem-sparing empiric treatment options in light of the new EUCAST recommendations
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Medientyp:
E-Artikel
Titel:
Antimicrobial resistance of bacteraemia in the emergency department of a German university hospital (2013–2018): potential carbapenem-sparing empiric treatment options in light of the new EUCAST recommendations
Beteiligte:
Rothe, Kathrin;
Wantia, Nina;
Spinner, Christoph D.;
Schneider, Jochen;
Lahmer, Tobias;
Waschulzik, Birgit;
Schmid, Roland M.;
Busch, Dirk H.;
Katchanov, Juri
Erschienen:
Springer Science and Business Media LLC, 2019
Beschreibung:
<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>This study investigated predominant microorganisms causing community-onset bacteraemia at the medical emergency department (ED) of a tertiary-care university hospital in Germany from 2013 to 2018 and their antimicrobial susceptibility patterns.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Antimicrobial resistance patterns in patients with positive blood cultures presenting to an internal medicine ED were retrospectively analysed.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>Blood cultures were obtained at 5191 of 66,879 ED encounters, with 1013 (19.5%) positive results, and true positive results at 740 encounters (diagnostic yield, 14.3%). The most frequently isolated relevant microorganisms were <jats:italic>Enterobacterales</jats:italic> (<jats:italic>n</jats:italic> = 439, 59.3%), <jats:italic>Staphylococcus aureus</jats:italic> (<jats:italic>n</jats:italic> = 92, 12.4%), <jats:italic>Streptococcus pneumoniae</jats:italic> (<jats:italic>n</jats:italic> = 34, 4.6%), <jats:italic>Pseudomonas aeruginosa</jats:italic> (<jats:italic>n</jats:italic> = 32, 4.3%), <jats:italic>Streptococcus pyogenes</jats:italic> (<jats:italic>n</jats:italic> = 16, 2.2%), <jats:italic>Enterococcus faecalis</jats:italic> (<jats:italic>n</jats:italic> = 18, 2.4%), and <jats:italic>Enterococcus faecium</jats:italic> (<jats:italic>n</jats:italic> = 12, 1.6%). Antimicrobial susceptibility testing revealed a high proportion of resistance against ampicillin-sulbactam in <jats:italic>Enterobacterales</jats:italic> (42.2%). The rate of methicillin-resistant <jats:italic>Staphylococcus aureus</jats:italic> was low (0.4%).</jats:p>
<jats:p>Piperacillin-tazobactam therapy provided coverage for 83.2% of all relevant pathogens using conventional breakpoints. Application of the new European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommendations increased the percentage of susceptible isolates to high-dose piperacillin-tazobactam to 92.8% (<jats:italic>p</jats:italic> < 0.001). Broad-spectrum carbapenems would only cover an additional 4.8%. The addition of vancomycin or linezolid extended coverage by just 1.7%.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Using an ureidopenicillin-beta-lactamase inhibitor combination at the high dose suggested by the new EUCAST recommendations provided nearly 93% coverage for relevant pathogens in patients with suspected bloodstream infection in our cohort. This might offer a safe option to reduce the empiric use of carbapenems. Our data support the absence of a general need for glycopeptides or oxazolidinones in empiric treatment.</jats:p>
</jats:sec>