Retrospective Cohort Study of Beta‑Lactam Treatment for Ampc‑Overexpressing Enterobacteriaceae in a French Intensive Care Unit: Clinical Outcomes and Associated Factors
Étude de Cohorte Rétrospective du Traitement par Bêta‑Lactamines des Infections à Entérobactéries Surproduisant une Ampc dans un Service de Réanimation Française : Issues Cliniques et Facteurs Associés
DOI:
https://doi.org/10.5281/zenodo.20126861Keywords:
AmpC, Beta-lactamase, Enterobacterales, Beta-lactams, ICU, Clinical failure, risk factorsAbstract
ABSTRACT
Introduction. Infections caused by group 3 Enterobacteriaceae overexpressing AmpC beta-lactamase (EB3-AmpC+) represent a major therapeutic challenge in intensive care. This study aimed to evaluate treatment and 28-day mortality in intensive care patients treated with beta-lactams for EB3-AmpC+ infection. Patients and Methods. We conducted a retrospective, observational, single-center study in the intensive care unit of Henri Mondor Hospital over a 23-month period (January 2018 to November 2020). Patients included were adults treated with beta-lactams for documented EB3-AmpC+ infection. Results. Among 54 patients initially screened, 34 met the inclusion criteria, with 25 (73.5%) having clinical success and 9 (26.5%) having clinical failure. Mean age was 62.06 ± 13.19 years, with a male predominance (82.4%). Significant risk factors for clinical failure included prior antibiotic treatment within three months (33.3% vs. 4%, p = 0.025) and the presence of collections (44.4% vs. 8%, p = 0.016). No significant differences were observed for initial severity scores (SOFA and IGS) between the two groups. Conclusion. Prior antibiotic exposure and the presence of infected collections are significant risk factors for clinical failure in patients infected with EB3-AmpC+. These results highlight the importance of rapid and appropriate management to improve the prognosis of this high-risk population.
RESUME
Introduction. Les infections causées par des entérobactéries du groupe 3 surexprimant la bêta-lactamase AmpC (EB3-AmpC+) constituent un défi thérapeutique majeur en soins intensifs. Cette étude visait à évaluer le traitement et la mortalité à 28 jours chez les patients en soins intensifs traités par des bêta-lactamines pour une infection à EB3-AmpC+. Patients et méthodes. Nous avons mené une étude rétrospective, observationnelle et monocentrique au sein de l'unité de soins intensifs de l'hôpital Henri Mondor sur une période de 23 mois (de janvier 2018 à novembre 2020). Les patients inclus étaient des adultes traités par des bêta-lactamines pour une infection EB3-AmpC+ confirmée. Résultats. Sur les 54 patients initialement sélectionnés, 34 répondaient aux critères d'inclusion ; 25 (73,5 %) ont présenté un succès clinique et 9 (26,5 %) un échec clinique. L'âge moyen était de 62,06 ± 13,19 ans, avec une prédominance masculine (82,4 %). Les facteurs de risque significatifs d'échec clinique comprenaient un traitement antibiotique antérieur au cours des trois derniers mois (33,3 % contre 4 %, p = 0,025) et la présence de collections (44,4 % contre 8 %, p = 0,016). Aucune différence significative n'a été observée entre les deux groupes en ce qui concerne les scores de gravité initiaux (SOFA et IGS). Conclusion. Une exposition antérieure aux antibiotiques et la présence de collections infectées constituent des facteurs de risque significatifs d'échec clinique chez les patients infectés par EB3-AmpC+. Ces résultats soulignent l'importance d'une prise en charge rapide et appropriée pour améliorer le pronostic de cette population à haut risque.
References
1. World Health Organization (WHO). First WHO report on antibiotic resistance: a serious global threat. WHO. Available at: https://www.who.int/mediacentre/news/releases/2014/amrreport/fr/.
2. Kaye KS, Cosgrove S, Harris A, Eliopoulos GM, and Yehuda C. Risk factors for the emergence of broad-spectrum cephalosporin resistance in Enterobacter species. Antimicrob Agents Chemother. 2001;45(9):2628-30.
3. Livermore DM. Beta-lactamases in laboratory and clinical resistance. Clin Microbiol Rev. 1995;8:557-84.
4. Goldstein FW. Induction of cephalosporinases and cephalosporin resistance: a longstanding misinterpretation. Clin Microbiol Infect. 2002;8:823-5.
5. Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America recommendations for the management of infections caused by AmpC β-lactamase-producing Enterobacteriaceae, carbapenem-resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia. Clin Infect Dis. 2022;74:2089-114.
6. Harris PNA, Tambyah PA, Lye DC, Mo Y, Lee TH, Yilmaz M, et al. Epidemiology and outcomes of bloodstream infections caused by multidrug-resistant Gram-negative bacteria in the Australian cohort. J Antimicrob Chemother. 2015;70(7):2089–94.
7. Paterson DL, Ko WC, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, et al. Antibiotic treatment of carbapenemase-producing Enterobacteriaceae from Klebsiella pneumoniae: current options and future prospects. Curr Opin Infect Dis. 2019;32(6):584–92.
8. Cornely OA, Cisneros JM, Torre-Cisneros J, Rodríguez-Hernández MJ, Gurgui M, Pachón J, et al. Empirical antibiotic therapy for suspected severe Gram-negative infections: Current approaches and perspectives. Clin Microbiol Infect. 2018;24(10):909–20.
9. Wang J, Chen J, Yang L, Li J, Hu H. In vitro activity of novel β-lactamase inhibitors in combination with β-lactam antibiotics against multidrug-resistant Gram-negative bacteria. Antimicrob Agents Chemother. 2019;63(11):e00840-19.
10. Mounier R, Le Guen R, Woerther PL, Nacher M, Bonnefon C, Mongardon N et al. Clinical outcome of infections caused by wild-type AmpC-producing Enterobacteriaceae in intensive care patients treated with β-lactams: a prospective multicenter study. Ann Intensive Care.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Kossi Odjo Dogbe YZ, Boulama Mahamadou MB, Soumana Diaouga H, Bachar Loukoumi O, Amadou Hamadou S, Daddy H, Chaibou MS
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License CC BY-NC-ND 4.0 that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
