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Master Thesis

Bacterial ecology and effects of initial empiric antimicrobial treatment in severe trauma patients

Abstract : Introduction: nosocomial infections and antimicrobial resistance are major concerns for intensive care unit (ICU) caregivers. Trauma population is specially underwent to an precocious antimicrobial (AT) exposure for several indications. The effect of an initial empiric AT (IEAT) on the bacterial ecology in severe trauma patients has never been studied. The aim of this study was to describe the early (from admission to day 5) and late (since day 6) bacterial ecology of severe trauma patients and to assess the effect of an IEAT on the emergence of resistance in this population. Methods: all trauma patients admitted in a Level 1 trauma centre between January 2010 and December 2015, has been screened. Patients with an Injury Severity Score (ISS) >16 and a trauma ICU length of stay > 10 were included. In addition to mains demographic and severity characteristics, details on IEAT and secondary AT have been reported. Finally, for each patient, all early (≤day 5) and late (>day 5) bacteriological sample, from admission to ICU discharge, were recorded as well as sample timing, sample site, bacterial strain and antimicrobial resistance. Results: 507 patients, of median ISS of 29 [IQR, 22-34], were included: 114 (22%) did not received IEAT (No-IEAT group), 95 (19%) received a short IEAT ≤ 3 days (Short-IEAT group), 298 (59%) received a long IEAT > 3 days (Long-IEAT group). In the entire cohort, early ecology was dominated by Staphylococcus aureus (SA), bacteria resident within the nasopharynx (RNP) and Group 0-1 Enterobacteria (29% of patients, 13% and 10%). Group 3 Enterobacteria and Pseudomonas aeruginosa (PA) were found in 11% and 6% of patients respectively. Late ecology was dominated by Group 3 Enterobacteria (22% of patients), Group 0-1 Enterobacteria (17%) and SA (20%). Group 2 Enterobacteria, PA and Acinetobacter were found in 10%, 11% and 5% of patients respectively. No difference of ecology repartition was found according to IEAT management. Resistance emerged essentially during the late period; hypercephalosporinase enterobacteria (HCASE) were present in 19% of patients, extended spectrum betalactamase (ESBL) enterobacteria in 4%, resistant PA in less than 4% and methicillin resistant SA in less than 1%. No difference was found regarding emergence of resistance according to the IEAT management. Conclusion: this work had permit to describe clearly the early and late bacterial ecology of a specific severe trauma population. In this population, resistance emergence is dominated by HCASE and no influence of IEAT has been revealed.
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Master Thesis
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Contributor : Scd Université de Montpellier <>
Submitted on : Tuesday, October 13, 2020 - 3:51:30 PM
Last modification on : Tuesday, June 22, 2021 - 11:36:02 AM


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  • HAL Id : dumas-02965892, version 1


Guillaume Faivre. Bacterial ecology and effects of initial empiric antimicrobial treatment in severe trauma patients. Human health and pathology. 2018. ⟨dumas-02965892⟩



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