title: Gram-negative bacteremia: which empirical antibiotic therapy?
abstract: OBJECTIVE
  Given the increasing frequency of cefotaxime-resistant strains, third-generation cephalosporins (3GC e.g. cefotaxime, ceftriaxone) might not be recommended any longer as empirical antibiotic therapy for community-acquired Gram-negative bacteremia (CA-GNB).
  
  
  METHODS
  We conducted a multicenter prospective descriptive study including patients with CA-GNB.
  
  
  RESULTS
  Two hundred and nineteen patients were included. Escherichia coli and Pseudomonas aeruginosa were the most frequently isolated species in 63% (n=138) and 11% (n=24) of the cases, respectively. The prevalence of cefotaxime-resistance reached 18% (n=39) mostly due to intrinsic resistance (27 cases, 12%). The presence of invasive material (P<0.001), the origin of the patient (Paris region or West of France) (P=0.006), and home health care (P<0.001) were variables predicting resistant GNB. The negative predictive value for resistance in patients with invasive material coming from the West of France, or without invasive material and with home health care was 94%. The positive predictive value for patients with invasive material living in Paris, or without invasive material and with home health care only reached 58 and 54%, respectively.
  
  
  CONCLUSIONS
  Using 3GC for CA-GNB due to cefotaxime-resistant strains was relatively frequent, ESBL-producing Enterobacteriaceae being rarely involved. Our study highlights the role of local epidemiology; before any changes to first-line antibiotic therapy, local epidemiological data should be taken into account.
authors.affiliation: Équipe Mobile d'infectiologie, Service de Maladies Infectieuses, CHU Necker-Enfants-Malades, AP-HP, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Shoai Tehrani
authors.affiliation: Département d'Épidémiologie et Recherche Clinique, Hôpital Louis-Mourier, Hôpitaux Universitaires Paris Nord Val-de-Seine, AP-HP, Colombes, France.
authors.forename: D
authors.initials: D
authors.lastname: Hajage
authors.affiliation: Service de Microbiologie-Hygiène, Hôpital Louis-Mourier, Hôpitaux Universitaires Paris Nord Val-de-Seine, AP-HP, Colombes, France.
authors.forename: V
authors.initials: V
authors.lastname: Fihman
authors.affiliation: Service de Microbiologie, CHU Saint-Antoine, AP-HP, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Tankovic
authors.affiliation: Service de Microbiologie-Hygiène, Hôpital Louis-Mourier, Hôpitaux Universitaires Paris Nord Val-de-Seine, AP-HP, Colombes, France.
authors.forename: S
authors.initials: S
authors.lastname: Cau
authors.affiliation: Service de Microbiologie, CHU Georges-Pompidou, AP-HP, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Day
authors.affiliation: Service de Microbiologie, CHU Georges-Pompidou, AP-HP, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Visseaux
authors.affiliation: Service de Microbiologie, CHU Georges-Pompidou, AP-HP, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Carbonnelle
authors.affiliation: Service de réanimation médicale, CHU d'Angers, Angers, France.
authors.forename: A
authors.initials: A
authors.lastname: Kouatchet
authors.affiliation: Service de Microbiologie, CHU Côte-de-Nacre, Caen, France.
authors.forename: V
authors.initials: V
authors.lastname: Cattoir
authors.affiliation: Service de Microbiologie, CHU Côte-de-Nacre, Caen, France.
authors.forename: T X
authors.initials: TX
authors.lastname: Nhan
authors.affiliation: Service de Microbiologie, CHU Hôtel-Dieu, Nantes, France.
authors.forename: S
authors.initials: S
authors.lastname: Corvec
authors.affiliation: Service de Microbiologie, CHU Lariboisière, AP-HP, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Jacquier
authors.affiliation: INSERM, UMR-S 722, Paris, France, Université Paris Nord, Sorbonne Paris Cité, UMR-S 722, Faculté de Médecine, Site Xavier-Bichat, 75018 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Jauréguy
authors.affiliation: Service de Microbiologie, CHG Versailles, Le Chesnay, France.
authors.forename: A
authors.initials: A
authors.lastname: Le Monnier
authors.affiliation: Service de Microbiologie, CHU Cochin, AP-HP, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Morand
authors.affiliation: Unité de Prévention et de Lutte contre les Infections Nosocomiales, CHU d'Angers, Université D'Angers, rue Larrey, 49000 Angers, France. Electronic address: JeanRalph.ZAHAR@chu-angers.fr.
authors.forename: J R
authors.initials: JR
authors.lastname: Zahar
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D018550:Cephalosporin Resistance; D017714:Community-Acquired Infections / Q000188:drug therapy; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bactériémie à Gram négatif; Bêta-lactamase à spectre étendu; Cefotaxime-resistance; Extended-spectrum b-lactamase; Gram-negative bacteremia; Health care-associated infection; Résistance au céfotaxime