Bacteremia
Conditions
Keywords
antibiogram, bacteremia
Brief summary
Bacteremia is defined as the presence of bacteria in the blood. They can potentially lead to life-threatening septic shock. Effective probabilistic antibiotic therapy must therefore be initiated immediately after blood cultures have been taken. To diagnose bacteremia, blood culture bottles must first be incubated, which allows bacterial growth and early detection. Then, as soon as the sample is positive, an antibiogram of the incriminated bacterium is carried out by inoculation on MH (Mueller Hinton) medium. This diffusion antibiogram is the reference method and is obtained 24 hours after the vial is positive, i.e. around 48 hours after blood cultures are taken. American recommendations agree that it is crucial to use rapid diagnostic tests to obtain the antibiogram. Antibiotic susceptibility test data can be used to broaden the spectrum of antibiotics in the event of ineffective therapy. They can also be used to reduce the spectrum of broad-spectrum antibiotics. This is part of the proper use of antibiotics and the reduction of multi-resistant bacteria (MRB) or highly resistant bacteria (HRB). Finally, it is also possible to carry out an early oral relay, thus avoiding intravenous infusions and their complications, and potentially reducing hospitalization times. The investigators have evaluated a rapid antibiogram by diffusion on MHR-SIR (Mueller-Hinton Rapid-SIR) medium from the blood culture bottle. The investigators were able to obtain antibiogram results 7 hours after blood culture positivity, with excellent correlation compared with the standard method after 24 hours incubation on MH (Mueller-Hinton). The antibiotics tested were the same as with the standard method. Secondly, The investigators were able to evaluate prospectively the impact of diffusion antibiotic susceptibility testing on MHR-SIR medium on early modification of antibiotic therapy in bacteremia, on 167 patients Antibiotic susceptibility test data on MHR-SIR enabled us to adapt antibiotic therapy 8 hours after blood culture positivity for 74 patients (44%). Antibiotic therapy was ineffective for 30 patients (18%) and was therefore extended. It also enabled us to reduce the spectrum of antibiotic therapy, in particular through early oral relay, for 44 patients (26%). The aim of this multicenter trial is to validate on a large scale this strategy for obtaining rapid antibiotic susceptibility test results, with significant consequences in terms of optimizing antibiotic therapy.
Interventions
DIAGNOSTIC_TESTAntibiotic susceptibility testing
antibiotic susceptibility testing is performed on MHR-SIR or MH medium depending on randomization
Sponsors
Fondation Hôpital Saint-Joseph
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Subject)
Intervention model description
cluster cross-over randomized trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age \>= 18 * Patient hospitalized in a clinical department of each participating center * Patient managed in the context of bacteremia (microbiological criterion = positive blood culture) * Patient with positive blood culture for Enterobacterales * Patient affiliated to a health insurance scheme * Patient/relative having given free, informed and express oral consent
Exclusion criteria
* Patients with non-enterobacterial bacteremia * Patient under guardianship * Patient deprived of liberty * Patient under court protection * Pregnant or breast-feeding patient
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effective Antiobiotherapy | 12 hours | percentage of patients with Enterobacterales bacteremia for whom antibiotic therapy was effective against the incriminating bacterium within 12 hours of a positive blood culture, according to the results of the antibiogram. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time Frame | 3days | Time between blood sampling and antibiogram results |
| type of Antibiotherapy spectra modification | 2 days | After obtaining the antibiogram result, was the antibiotherapy modified (Yes or No) and if yes, was it for narrowing the antibiotic spectra (yes or no) |
| Time necessary to modify the spectrum of probabilistic antibiotic therapy after the antibiogram results | 2 days | in hours |
| time between the start of intravenous antibiotic therapy and oral antibiotics. | 1month | in days |
| length of hospital stay | 1 month | In days, |
Countries
France
Contacts
Primary ContactHelene BEAUSSIER
Backup ContactJuliette COURTIADE MAHLER
Outcome results
None listed