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MADRID – A targeted antibiotic strategy that employed ertapenem in carriers of extended-spectrum beta-lactamase–producing Enterobacteriaceae reduced infections after colorectal surgery by 41%, compared with routine treatment with cefuroxime and metronidazole.
The strategy was even more effective at preventing surgical site infections caused by ESBL-producing bacteria, cutting the rate by 87%, Amir Nutman, MD, said at the European Congress of Clinical Microbiology and Infectious Diseases.
He presented the results of the WP4 study, which was carried out in three hospitals in Serbia, Switzerland, and Israel. Designed as a before-and-after trial, it tested the theory that identifying ESBL carriers and targeting presurgical antibiotic prophylaxis could improve their surgical outcomes.
WP4 was one of five studies in the multinational R-GNOSIS project. “Resistance in gram-negative organisms: Studying intervention strategies” is a 12 million euro, 5-year European collaborative research project designed to identify effective interventions for reducing the carriage, infection, and spread of multidrug resistant Gram-negative bacteria. Several of the studies reported at ECCMID 2018.
During 2012-2017, WP4 enrolled almost 4,000 adults scheduled to undergo colorectal surgery (excluding appendectomy or minor anorectal procedures). All patients were screened for ESBL-producing bacteria from 2 weeks to 2 days before their operation. In the first phase, carriers were treated with the standard presurgical prophylaxis of 1.5 g cefuroxime and 500 mg metronidazole intravenously. In phase 2, carriers received targeted prophylaxis with IV ertapenem 1 g. Both interventions were given 30 minutes before surgery commenced.
All patients underwent regular surgical site infection surveillance until hospital discharge, then followed up 30 days later by phone or in person.
The primary outcome was surgical site infection at 30 days. Secondary outcomes were the type of any surgical site infection (superficial, deep, or organ/space), and infections caused by ESBL-producing bacteria.
ESBL screening was carried out on 3,626 patients; carriage prevalence was 13.8%, but varied by center from 9% to 29%. Of the carriers, 468 were included in the study; 247 received routine prophylaxis and 221 received ertapenem.
Patients were a mean of 63 years old; 98% were living at home before admission. About 20% had diabetes; 5% had some type of immunodeficiency. The most common surgical indication was colon cancer (68%), and about a third had undergone prior colon surgery. Most of the surgeries were open, and about half involved a colectomy.
Patients in the ertapenem group had overall better scores on the National Nosocomial Infections Surveillance Basic SSI Risk Index and were less likely to have an intraoperative finding of colon dilation (20.8% vs. 27%).There were no other clinically compelling intraoperative differences between the two groups, including bleeding, bowel spillage, the need for drains, or stoma placement.
Patients who received prophylactic ertapenem had significantly better 30-day outcomes on all measures of infection than did patients who had standard prophylaxis, Dr. Nutman said.
There were 34 surgical site infections in the routine prophylaxis group and 19 in the ertapenem group. Among these, 17 in the routine group and three in the ertapenem group were caused by ESBL-producing bacteria. The ESBL-positive infections were as follows:
- E. coli (thirteen in the routine and one in the ertapenem group).
- Klebsiella species (four and one, respectively).
- Proteus species (one in the ertapenem group).
Other infections were caused by ESBL-nonproducers, including E. coli, Klebsiella, Proteus, Enterococci, Pseudomonas aeruginosa, Staphylococcus aureus, and other unspecified organisms. Polymicrobial infections occurred in 25 patients.
In an analysis that controlled for National Nosocomial Infections Surveillance score and colon dilation, patients who received ertapenem were 41% less likely to develop any surgical site infection (15.8% vs. 22.7%; odds ratio, 0.59); 17% less likely to develop a deep infection (9.5% vs. 11.3%; OR, 0.83); and 87% less likely to develop an infection caused by an ESBL-producing bacteria (0.9% vs. 6.5%; OR, 0.13).
Dr. Nutman made no financial declarations.
SOURCE: Nutman et al. ECCMID 2018, Abstract O1129.
MADRID – A targeted antibiotic strategy that employed ertapenem in carriers of extended-spectrum beta-lactamase–producing Enterobacteriaceae reduced infections after colorectal surgery by 41%, compared with routine treatment with cefuroxime and metronidazole.
The strategy was even more effective at preventing surgical site infections caused by ESBL-producing bacteria, cutting the rate by 87%, Amir Nutman, MD, said at the European Congress of Clinical Microbiology and Infectious Diseases.
He presented the results of the WP4 study, which was carried out in three hospitals in Serbia, Switzerland, and Israel. Designed as a before-and-after trial, it tested the theory that identifying ESBL carriers and targeting presurgical antibiotic prophylaxis could improve their surgical outcomes.
WP4 was one of five studies in the multinational R-GNOSIS project. “Resistance in gram-negative organisms: Studying intervention strategies” is a 12 million euro, 5-year European collaborative research project designed to identify effective interventions for reducing the carriage, infection, and spread of multidrug resistant Gram-negative bacteria. Several of the studies reported at ECCMID 2018.
During 2012-2017, WP4 enrolled almost 4,000 adults scheduled to undergo colorectal surgery (excluding appendectomy or minor anorectal procedures). All patients were screened for ESBL-producing bacteria from 2 weeks to 2 days before their operation. In the first phase, carriers were treated with the standard presurgical prophylaxis of 1.5 g cefuroxime and 500 mg metronidazole intravenously. In phase 2, carriers received targeted prophylaxis with IV ertapenem 1 g. Both interventions were given 30 minutes before surgery commenced.
All patients underwent regular surgical site infection surveillance until hospital discharge, then followed up 30 days later by phone or in person.
The primary outcome was surgical site infection at 30 days. Secondary outcomes were the type of any surgical site infection (superficial, deep, or organ/space), and infections caused by ESBL-producing bacteria.
ESBL screening was carried out on 3,626 patients; carriage prevalence was 13.8%, but varied by center from 9% to 29%. Of the carriers, 468 were included in the study; 247 received routine prophylaxis and 221 received ertapenem.
Patients were a mean of 63 years old; 98% were living at home before admission. About 20% had diabetes; 5% had some type of immunodeficiency. The most common surgical indication was colon cancer (68%), and about a third had undergone prior colon surgery. Most of the surgeries were open, and about half involved a colectomy.
Patients in the ertapenem group had overall better scores on the National Nosocomial Infections Surveillance Basic SSI Risk Index and were less likely to have an intraoperative finding of colon dilation (20.8% vs. 27%).There were no other clinically compelling intraoperative differences between the two groups, including bleeding, bowel spillage, the need for drains, or stoma placement.
Patients who received prophylactic ertapenem had significantly better 30-day outcomes on all measures of infection than did patients who had standard prophylaxis, Dr. Nutman said.
There were 34 surgical site infections in the routine prophylaxis group and 19 in the ertapenem group. Among these, 17 in the routine group and three in the ertapenem group were caused by ESBL-producing bacteria. The ESBL-positive infections were as follows:
- E. coli (thirteen in the routine and one in the ertapenem group).
- Klebsiella species (four and one, respectively).
- Proteus species (one in the ertapenem group).
Other infections were caused by ESBL-nonproducers, including E. coli, Klebsiella, Proteus, Enterococci, Pseudomonas aeruginosa, Staphylococcus aureus, and other unspecified organisms. Polymicrobial infections occurred in 25 patients.
In an analysis that controlled for National Nosocomial Infections Surveillance score and colon dilation, patients who received ertapenem were 41% less likely to develop any surgical site infection (15.8% vs. 22.7%; odds ratio, 0.59); 17% less likely to develop a deep infection (9.5% vs. 11.3%; OR, 0.83); and 87% less likely to develop an infection caused by an ESBL-producing bacteria (0.9% vs. 6.5%; OR, 0.13).
Dr. Nutman made no financial declarations.
SOURCE: Nutman et al. ECCMID 2018, Abstract O1129.
MADRID – A targeted antibiotic strategy that employed ertapenem in carriers of extended-spectrum beta-lactamase–producing Enterobacteriaceae reduced infections after colorectal surgery by 41%, compared with routine treatment with cefuroxime and metronidazole.
The strategy was even more effective at preventing surgical site infections caused by ESBL-producing bacteria, cutting the rate by 87%, Amir Nutman, MD, said at the European Congress of Clinical Microbiology and Infectious Diseases.
He presented the results of the WP4 study, which was carried out in three hospitals in Serbia, Switzerland, and Israel. Designed as a before-and-after trial, it tested the theory that identifying ESBL carriers and targeting presurgical antibiotic prophylaxis could improve their surgical outcomes.
WP4 was one of five studies in the multinational R-GNOSIS project. “Resistance in gram-negative organisms: Studying intervention strategies” is a 12 million euro, 5-year European collaborative research project designed to identify effective interventions for reducing the carriage, infection, and spread of multidrug resistant Gram-negative bacteria. Several of the studies reported at ECCMID 2018.
During 2012-2017, WP4 enrolled almost 4,000 adults scheduled to undergo colorectal surgery (excluding appendectomy or minor anorectal procedures). All patients were screened for ESBL-producing bacteria from 2 weeks to 2 days before their operation. In the first phase, carriers were treated with the standard presurgical prophylaxis of 1.5 g cefuroxime and 500 mg metronidazole intravenously. In phase 2, carriers received targeted prophylaxis with IV ertapenem 1 g. Both interventions were given 30 minutes before surgery commenced.
All patients underwent regular surgical site infection surveillance until hospital discharge, then followed up 30 days later by phone or in person.
The primary outcome was surgical site infection at 30 days. Secondary outcomes were the type of any surgical site infection (superficial, deep, or organ/space), and infections caused by ESBL-producing bacteria.
ESBL screening was carried out on 3,626 patients; carriage prevalence was 13.8%, but varied by center from 9% to 29%. Of the carriers, 468 were included in the study; 247 received routine prophylaxis and 221 received ertapenem.
Patients were a mean of 63 years old; 98% were living at home before admission. About 20% had diabetes; 5% had some type of immunodeficiency. The most common surgical indication was colon cancer (68%), and about a third had undergone prior colon surgery. Most of the surgeries were open, and about half involved a colectomy.
Patients in the ertapenem group had overall better scores on the National Nosocomial Infections Surveillance Basic SSI Risk Index and were less likely to have an intraoperative finding of colon dilation (20.8% vs. 27%).There were no other clinically compelling intraoperative differences between the two groups, including bleeding, bowel spillage, the need for drains, or stoma placement.
Patients who received prophylactic ertapenem had significantly better 30-day outcomes on all measures of infection than did patients who had standard prophylaxis, Dr. Nutman said.
There were 34 surgical site infections in the routine prophylaxis group and 19 in the ertapenem group. Among these, 17 in the routine group and three in the ertapenem group were caused by ESBL-producing bacteria. The ESBL-positive infections were as follows:
- E. coli (thirteen in the routine and one in the ertapenem group).
- Klebsiella species (four and one, respectively).
- Proteus species (one in the ertapenem group).
Other infections were caused by ESBL-nonproducers, including E. coli, Klebsiella, Proteus, Enterococci, Pseudomonas aeruginosa, Staphylococcus aureus, and other unspecified organisms. Polymicrobial infections occurred in 25 patients.
In an analysis that controlled for National Nosocomial Infections Surveillance score and colon dilation, patients who received ertapenem were 41% less likely to develop any surgical site infection (15.8% vs. 22.7%; odds ratio, 0.59); 17% less likely to develop a deep infection (9.5% vs. 11.3%; OR, 0.83); and 87% less likely to develop an infection caused by an ESBL-producing bacteria (0.9% vs. 6.5%; OR, 0.13).
Dr. Nutman made no financial declarations.
SOURCE: Nutman et al. ECCMID 2018, Abstract O1129.
REPORTING FROM ECCMID 2018
Key clinical point: A targeted presurgical antibiotic prophylaxis significantly cut rates of surgical site infections in carriers of extended beta-lactamase–producing bacteria.
Major finding: Ertapenem reduced the rate of surgical site infection by 41% , and the rate of ESBL-producing infections by 87%, compared to routine prophylaxis.
Study details: The study comprised 468 patients.
Disclosures: The study was funded by the European Commission under the Seventh Framework Programme (FP7) for Research and Technology. Dr. Nutman had no financial disclosures.
Source: Nutman A et al. ECCMID 2018, Abstract O1129