Empiric treatment of healthcare-associated central nervous system infections in Denmark: do we need carbapenems?
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Empiric treatment of healthcare-associated central nervous system infections in Denmark : do we need carbapenems? / Kraef, Christian; Hertz, Frederik Boetius; Riis Olesen, Birthe; Sigurdsson, Sigurdur Thor; Bergdal, Ove Ketil; Gitz Holler, Jon; Mens, Helene; Helweg-Larsen, Jannik; Andersen, Åse Bengaard; Møller, Kirsten; Knudsen, Jenny Dahl.
I: Infectious Diseases, Bind 56, Nr. 5, 2024, s. 402-409.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Empiric treatment of healthcare-associated central nervous system infections in Denmark
T2 - do we need carbapenems?
AU - Kraef, Christian
AU - Hertz, Frederik Boetius
AU - Riis Olesen, Birthe
AU - Sigurdsson, Sigurdur Thor
AU - Bergdal, Ove Ketil
AU - Gitz Holler, Jon
AU - Mens, Helene
AU - Helweg-Larsen, Jannik
AU - Andersen, Åse Bengaard
AU - Møller, Kirsten
AU - Knudsen, Jenny Dahl
N1 - Publisher Copyright: © 2024 Society for Scandinavian Journal of Infectious Diseases.
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
KW - Antimicrobial stewardship
KW - Carbapenem-sparing
KW - Cephalosporin
KW - CNS-infections
KW - Denmark
U2 - 10.1080/23744235.2024.2315478
DO - 10.1080/23744235.2024.2315478
M3 - Journal article
C2 - 38339990
AN - SCOPUS:85184926848
VL - 56
SP - 402
EP - 409
JO - Infectious Diseases
JF - Infectious Diseases
SN - 2374-4235
IS - 5
ER -
ID: 388046315