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Master Thesis

Étude rétrospective des modalités et de l’impact de l’antibiothérapie probabiliste dans les bactériémies à entérobactéries du sujet âgé

Abstract : Introduction: enterobacteriaceae (EB) bloodstream infections (BSI) are frequent and serious in older patients, who are at risk for multidrug resistance (MDR). Physicians are faced with the dilemma of prescribing adequate antibiotic (AB), considering MDR risk factors and sparing broad-spectrum AB prescription. The objective of the study was to determine whether the empiric AB introduced to treat EB BSI is adequate in older patients. Material and methods: 49 French and Belgian centers enrolled retrospectively up to 10 patients aged 75 and over recently hospitalized with EB bacteremia. Results: the 505 enrolled patients (mean age 86 +/-5,9) were mostly dependent (ADL score 4,5; IQR 2,5;6); 70% had at least one risk factor of being infected by EB-ESBL. E. coli was the most frequent pathogen (n=353, 70%), concordant with a majority of UTI as source of infection (70%); 11% were resistance to 3rd generation cephalosporins (3CG). Infection was severe in 29% of cases; 434 (86%) received an empirical AB (32% of dual therapy), which was adequate in 87% of cases. 3CG prescription (262/434, 60,3%) were most common. Prescription of carbapenems as first line was not frequent (n=14, 3%). Inhospital mortality rate was 17% (n=85). Prescription of an inappropriate AB (i.e. no AB prescription before BSI positivity, or inadequate AB) was not associated with mortality. At discharge, 278 (46%) patients experienced a functional decline. Conclusion: this study confirmed that EB-BSI is a severe event for older patients (mortality and functional decline). Empirical antimicrobial treatment was adequate in most cases sparing carbapenems even with a high prevalence of MDR risk factors. The proportion of the dual antibiotherapies with aminosides is important, sometimes without any gravity sign, querying on the pertinence of this prescription in this fragile population.
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https://dumas.ccsd.cnrs.fr/dumas-03011880
Contributor : Médecine Ub <>
Submitted on : Wednesday, November 18, 2020 - 12:13:57 PM
Last modification on : Saturday, December 19, 2020 - 3:12:50 AM
Long-term archiving on: : Friday, February 19, 2021 - 7:20:05 PM

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  • HAL Id : dumas-03011880, version 1

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Albane Roseau-Vincenti. Étude rétrospective des modalités et de l’impact de l’antibiothérapie probabiliste dans les bactériémies à entérobactéries du sujet âgé. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03011880⟩

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