Évaluation d’un protocole anti-infectieux probabiliste au cours de la prise en charge chirurgicale des infections de prothèses aortiques : étude rétrospective monocentrique

Abstract : Background: aortic graft infections (AGI) are rare but often associated with severe complications with a high death rate (37%). If not previously started, an antimicrobial therapy must be started intra-operatively but there is not consensus about the ideal empirical treatment. The aim of this study was to analyze and report the bacterial epidemiology and prognosis of AGI in the intensive care unit (ICU) in order to reassess this empirical therapy. Study Design: retrospective clinical study Methods: between March 2008 and March 2018, all consecutive patients treated for suspected aortic graft infection were included. There were two groups, group 1 referring to the first study period, before March 2011 in which patients were treated without an empirical per-operative anti-infectious protocol and group 2 with patients who have to be treated with carbapenem and anti-methicillin resistant Staphylococcus aureus (MRSA) as first line antibiotherapy. Echinocandin was added if aorto-enteric fistula (AEF) was suspected. Primary outcome was the appropriateness of antibiotherapy. Thirty-day and in-hospital mortality were defined as secondary outcome. Results: during the study period, 118 patients were admitted to our university hospital for AGI. Gram positive cocci (GPC) were the most commonly implicated (n=104), with streptococci (n=39), enterococci (n=21) and staphylococci (n=18 with 8 methicillin resistant), followed by enterobacteria (n=59) including Escherichia coli (n=30) and Enterobacter spp. (n=11). Forty yeasts were isolated in 34 patients. Adequate antimicrobial therapy was performed in 96 patients (81%), 19 in group 1 (70%) and 77 in group 2 (85%). Regarding Gram negative bacilli (GNB), 24% were resistant or intermediary to piperacillin-tazobactam (PTZ). Using a combination of carbapenem with anti MRSA as initial empirical treatment, we would achieve 99% coverage with the first line treatment. Thirty-day mortality rate was 24% and in hospital mortality rate was 37%. Conclusion: aortic graft infection carries high morbidity and mortality rates. We recommend the use of carbapenem with anti-MRSA as first line antibiotherapy in AGI, with echinocandin in case of AEF.
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Maxime Poteau. Évaluation d’un protocole anti-infectieux probabiliste au cours de la prise en charge chirurgicale des infections de prothèses aortiques : étude rétrospective monocentrique. Médecine humaine et pathologie. 2018. ⟨dumas-02088229⟩

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