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- Title:
Antimicrobial resistance of bacteraemia in the emergency department of a German university hospital (2013-2018): potential carbapenem-sparing empiric treatment options in light of the new EUCAST recommendations.
- Document type:
- Journal Article
- Author(s):
- Rothe, Kathrin; Wantia, Nina; Spinner, Christoph D; Schneider, Jochen; Lahmer, Tobias; Waschulzik, Birgit; Schmid, Roland M; Busch, Dirk H; Katchanov, Juri
- Abstract:
- BACKGROUND: This study investigated predominant microorganisms causing community-onset bacteraemia at the medical emergency department (ED) of a tertiary-care university hospital in Germany from 2013 to 2018 and their antimicrobial susceptibility patterns. METHODS: Antimicrobial resistance patterns in patients with positive blood cultures presenting to an internal medicine ED were retrospectively analysed. RESULTS: Blood cultures were obtained at 5191 of 66,879 ED encounters, with 1013 (19.5%) positive results, and true positive results at 740 encounters (diagnostic yield, 14.3%). The most frequently isolated relevant microorganisms were Enterobacterales (n = 439, 59.3%), Staphylococcus aureus (n = 92, 12.4%), Streptococcus pneumoniae (n = 34, 4.6%), Pseudomonas aeruginosa (n = 32, 4.3%), Streptococcus pyogenes (n = 16, 2.2%), Enterococcus faecalis (n = 18, 2.4%), and Enterococcus faecium (n = 12, 1.6%). Antimicrobial susceptibility testing revealed a high proportion of resistance against ampicillin-sulbactam in Enterobacterales (42.2%). The rate of methicillin-resistant Staphylococcus aureus was low (0.4%). Piperacillin-tazobactam therapy provided coverage for 83.2% of all relevant pathogens using conventional breakpoints. Application of the new European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommendations increased the percentage of susceptible isolates to high-dose piperacillin-tazobactam to 92.8% (p < 0.001). Broad-spectrum carbapenems would only cover an additional 4.8%. The addition of vancomycin or linezolid extended coverage by just 1.7%. CONCLUSIONS: Using an ureidopenicillin-beta-lactamase inhibitor combination at the high dose suggested by the new EUCAST recommendations provided nearly 93% coverage for relevant pathogens in patients with suspected bloodstream infection in our cohort. This might offer a safe option to reduce the empiric use of carbapenems. Our data support the absence of a general need for glycopeptides or oxazolidinones in empiric treatment.
- Journal title abbreviation:
- BMC Infect Dis
- Year:
- 2019
- Journal volume:
- 19
- Journal issue:
- 1
- Fulltext / DOI:
- doi:10.1186/s12879-019-4721-9
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/31888581
- Print-ISSN:
- 1471-2334
- TUM Institution:
- II. Medizinische Klinik und Poliklinik (Gastroenterologie); Institut für Medizinische Mikrobiologie, Immunologie und Hygiene; Institut für Medizinische Statistik und Epidemiologie
BibTeX
Occurrences:
- mediaTUM GesamtbestandHochschulbibliographie2019FakultätenMedizinInstitut für Medizinische Mikrobiologie, Immunologie und Hygiene
- mediaTUM GesamtbestandEinrichtungenSchools TUM School of Medicine and HealthDepartmentsClinical MedicineInstitut für KI und Informatik in der Medizin (Prof. Rückert)2019
- mediaTUM GesamtbestandHochschulbibliographie2019FakultätenMedizinInstitut für Medizinische Statistik und Epidemiologie