Empiric treatment of healthcare-associated central nervous system infections in Denmark : do we need carbapenems?
BACKGROUND: Carbapenems are widely used for empiric treatment of healthcare-associated central nervous system (CNS) infections. We investigated the feasibility of a carbapenem-sparing strategy, utilising a third-generation cephalosporin (ceftriaxone or cefotaxime) (combined with vancomycin) for the empirical treatment of healthcare-associated CNS infections in Eastern Denmark.
METHODS: The departments of neurosurgery and neuro-intensive care at Copenhagen University Hospital Rigshospitalet. First, we analysed local microbiological data (1st January 2020-31st August 2022) to identify microorganisms non-susceptible to third-generation cephalosporin. Subsequently, we assessed all carbapenem prescriptions over a three-month period for their indication and justification.
RESULTS: In total, 25,247 bacterial cultures were identified, of which 2,563 CNS-related, were included in the analysis. The positivity rate was 10.5% (n = 257/2439) for cerebrospinal-fluid samples and 75.8% (n = 95/124) for brain parenchyma. CNS samples from five individual patients revealed bacteria non-susceptible to third generation cephalosporins (Enterobacter spp. (n = 3), Pseudomonas spp. (n = 2), Klebsiella spp. (n = 2), Citrobacter freundii (n = 1)). All five patients had been hospitalised for ≥10days at the time-point of antibiotic therapy. Out of 11,626 sets of blood cultures, a total of 10 individual patients had Gram-negative blood-stream infections with resistance to ceftriaxone and piperacillin/tazobactam. 140 days-of-therapy (32%) with carbapenem in 18 patients (36%) were definitively or possibly indicated according to guidelines, none were indicated for healthcare-associated CNS-infections.
CONCLUSION: An empiric treatment strategy relying on a third-generation cephalosporin appears suitable for healthcare-associated CNS infections at our tertiary hospital, serving a population of 2.6 million. However, in patients with prolonged hospitalization (≥10 days), immunosuppression, prior broad-spectrum antibiotic use, or history of resistant Gram-negative bacteria, empirical prescription of carbapenem may be needed.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:56 |
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| Enthalten in: |
Infectious diseases (London, England) - 56(2024), 5 vom: 01. Apr., Seite 402-409 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kraef, Christian [VerfasserIn] |
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| Links: |
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| Themen: |
75J73V1629 |
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| Anmerkungen: |
Date Completed 03.04.2024 Date Revised 03.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1080/23744235.2024.2315478 |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Empiric treatment of healthcare-associated central nervous system infections in Denmark |b do we need carbapenems? |
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| 520 | |a BACKGROUND: Carbapenems are widely used for empiric treatment of healthcare-associated central nervous system (CNS) infections. We investigated the feasibility of a carbapenem-sparing strategy, utilising a third-generation cephalosporin (ceftriaxone or cefotaxime) (combined with vancomycin) for the empirical treatment of healthcare-associated CNS infections in Eastern Denmark | ||
| 520 | |a METHODS: The departments of neurosurgery and neuro-intensive care at Copenhagen University Hospital Rigshospitalet. First, we analysed local microbiological data (1st January 2020-31st August 2022) to identify microorganisms non-susceptible to third-generation cephalosporin. Subsequently, we assessed all carbapenem prescriptions over a three-month period for their indication and justification | ||
| 520 | |a RESULTS: In total, 25,247 bacterial cultures were identified, of which 2,563 CNS-related, were included in the analysis. The positivity rate was 10.5% (n = 257/2439) for cerebrospinal-fluid samples and 75.8% (n = 95/124) for brain parenchyma. CNS samples from five individual patients revealed bacteria non-susceptible to third generation cephalosporins (Enterobacter spp. (n = 3), Pseudomonas spp. (n = 2), Klebsiella spp. (n = 2), Citrobacter freundii (n = 1)). All five patients had been hospitalised for ≥10days at the time-point of antibiotic therapy. Out of 11,626 sets of blood cultures, a total of 10 individual patients had Gram-negative blood-stream infections with resistance to ceftriaxone and piperacillin/tazobactam. 140 days-of-therapy (32%) with carbapenem in 18 patients (36%) were definitively or possibly indicated according to guidelines, none were indicated for healthcare-associated CNS-infections | ||
| 520 | |a CONCLUSION: An empiric treatment strategy relying on a third-generation cephalosporin appears suitable for healthcare-associated CNS infections at our tertiary hospital, serving a population of 2.6 million. However, in patients with prolonged hospitalization (≥10 days), immunosuppression, prior broad-spectrum antibiotic use, or history of resistant Gram-negative bacteria, empirical prescription of carbapenem may be needed | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Antimicrobial stewardship | |
| 650 | 4 | |a CNS-infections | |
| 650 | 4 | |a Carbapenem-sparing | |
| 650 | 4 | |a Cephalosporin | |
| 650 | 4 | |a Denmark | |
| 650 | 7 | |a Carbapenems |2 NLM | |
| 650 | 7 | |a Ceftriaxone |2 NLM | |
| 650 | 7 | |a 75J73V1629 |2 NLM | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Hertz, Frederik Boetius |e verfasserin |4 aut | |
| 700 | 1 | |a Riis Olesen, Birthe |e verfasserin |4 aut | |
| 700 | 1 | |a Sigurdsson, Sigurdur Thor |e verfasserin |4 aut | |
| 700 | 1 | |a Bergdal, Ove Ketil |e verfasserin |4 aut | |
| 700 | 1 | |a Gitz Holler, Jon |e verfasserin |4 aut | |
| 700 | 1 | |a Mens, Helene |e verfasserin |4 aut | |
| 700 | 1 | |a Helweg-Larsen, Jannik |e verfasserin |4 aut | |
| 700 | 1 | |a Andersen, Åse Bengaard |e verfasserin |4 aut | |
| 700 | 1 | |a Møller, Kirsten |e verfasserin |4 aut | |
| 700 | 1 | |a Knudsen, Jenny Dahl |e verfasserin |4 aut | |
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