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Bronchard, Régis / Kerbaul, François

2023 Volume 68, Issue 878, Page(s) 54–55

Title translation	Quel avenir pour le prélèvement d’organes et de tissus ?
MeSH term(s)	Humans ; Tissue and Organ Procurement
Language	French
Publishing date	2023-08-14
Publishing country	France
Document type	Journal Article
ZDB-ID	604655-1
ISSN	0038-0814
ISSN	0038-0814
DOI	10.1016/j.soin.2023.07.014
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Article ; Online: Effect of Cardiac Arrest in Brain-dead Donors on Kidney Graft Function.

Dubourg, Quentin / Savoye, Emilie / Drouin, Sarah / Legeai, Camille / Barrou, Benoit / Rondeau, Eric / Buob, David / Kerbaul, Francois / Bronchard, Régis / Galichon, Pierre

Transplantation

2023 Volume 108, Issue 3, Page(s) 768–776

Abstract: Background: Cardiac arrest (CA) causes renal ischemia in one-third of brain-dead kidney donors before procurement. We hypothesized that the graft function depends on the time interval between CA and organ procurement.: Methods: We conducted a ... ...

Abstract	Background: Cardiac arrest (CA) causes renal ischemia in one-third of brain-dead kidney donors before procurement. We hypothesized that the graft function depends on the time interval between CA and organ procurement. Methods: We conducted a retrospective population-based study on a prospectively curated database. We included 1469 kidney transplantations from donors with a history of resuscitated CA in 2015-2017 in France. CA was the cause of death (primary CA) or an intercurrent event (secondary CA). The main outcome was the percentage of delayed graft function, defined by the use of renal replacement therapy within the first week posttransplantation. Results: Delayed graft function occurred in 31.7% of kidney transplantations and was associated with donor function, vasopressors, cardiovascular history, donor and recipient age, body mass index, cold ischemia time, and time to procurement after primary cardiac arrest. Short cold ischemia time, perfusion device use, and the absence of cardiovascular comorbidities were protected by multivariate analysis, whereas time <3 d from primary CA to procurement was associated with delayed graft function (odds ratio 1.38). Conclusions: This is the first description of time to procurement after a primary CA as a risk factor for delayed graft function. Delaying procurement after CA should be evaluated in interventional studies.
MeSH term(s)	Humans ; Kidney Transplantation/adverse effects ; Delayed Graft Function/etiology ; Retrospective Studies ; Graft Survival ; Kidney ; Tissue Donors ; Tissue and Organ Procurement ; Brain Death ; Heart Arrest/epidemiology ; Heart Arrest/etiology ; Brain
Language	English
Publishing date	2023-10-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000004825
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Article ; Online: Brain-Dead Donors on Extracorporeal Membrane Oxygenation.

Bronchard, Régis / Durand, Louise / Legeai, Camille / Cohen, Johana / Guerrini, Patrice / Bastien, Olivier

Critical care medicine

2017 Volume 45, Issue 10, Page(s) 1734–1741

Abstract: Objectives: To describe donors after brain death with ongoing extracorporeal membrane oxygenation and to analyze the outcome of organs transplanted from these donors.: Design: Retrospective analysis of the national information system run by the ... ...

Abstract	Objectives: To describe donors after brain death with ongoing extracorporeal membrane oxygenation and to analyze the outcome of organs transplanted from these donors. Design: Retrospective analysis of the national information system run by the French Biomedicine Agency (CRISTAL database). Setting: National registry data of all donors after brain death in France and their organ recipients between 2007 and 2013. Patients: Donors after brain death and their organ recipients. Interventions: None. Measurements and main results: During the study period, there were 22,270 brain-dead patients diagnosed in France, of whom 161 with extracorporeal membrane oxygenation. Among these patients, 64 donors on extracorporeal membrane oxygenation and 10,805 donors without extracorporeal membrane oxygenation had at least one organ retrieved. Donors on extracorporeal membrane oxygenation were significantly younger and had more severe intensive care medical conditions (hemodynamic, biological, renal, and liver insults) than donors without extracorporeal membrane oxygenation. One hundred nine kidneys, 37 livers, seven hearts, and one lung were successfully transplanted from donors on extracorporeal membrane oxygenation. We found no significant difference in 1-year kidney graft survival (p = 0.24) and function between recipients from donors on extracorporeal membrane oxygenation (92.7% [85.9-96.3%]) and matching recipients from donors without extracorporeal membrane oxygenation (95.4% [93.0-97.0%]). We also found no significant difference in 1-year liver recipient survival (p = 0.91): 86.5% (70.5-94.1) from donors on extracorporeal membrane oxygenation versus 80.7% (79.8-81.6) from donors without extracorporeal membrane oxygenation. Conclusions: Brain-dead patients with ongoing extracorporeal membrane oxygenation have more severe medical conditions than those without extracorporeal membrane oxygenation. However, kidney graft survival and function were no different than usual. Brain-dead patients with ongoing extracorporeal membrane oxygenation are suitable for organ procurement.
MeSH term(s)	Adult ; Aged ; Brain Death ; Extracorporeal Membrane Oxygenation/statistics & numerical data ; Female ; France ; Graft Survival ; Humans ; Male ; Middle Aged ; Organ Transplantation/statistics & numerical data ; Retrospective Studies ; Tissue Donors/statistics & numerical data ; Young Adult
Language	English
Publishing date	2017-06-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000002564
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Article ; Online: Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: results from a French survey.

Champigneulle, Benoit / Neuschwander, Arthur / Bronchard, Régis / Favé, Gersende / Josserand, Julien / Lebas, Benjamin / Bastien, Olivier / Pirracchio, Romain

BMC anesthesiology

2019 Volume 19, Issue 1, Page(s) 108

Abstract: Background: This study aimed at describing usual anesthetic practices for brain-dead donors (BDD) during an organ procurement (OP) procedure and to assess the knowledge and self-confidence of French anesthesiologists with this practice.: Methods: An ... ...

Abstract	Background: This study aimed at describing usual anesthetic practices for brain-dead donors (BDD) during an organ procurement (OP) procedure and to assess the knowledge and self-confidence of French anesthesiologists with this practice. Methods: An electronic and anonymous survey with closed-questions about anesthetic management of BDD was distributed to French anesthesiologists via the mailing list of the French Society of Anesthesiology and Intensive Care Medicine. Results: Four hundred fifty-eight responses were analyzed. Respondents were mainly attending physicians with more than 10 years of clinical experience. 78% of them declared being cognizant of guidelines regarding management of BDD. Advanced hemodynamic monitoring and endocrine substitution were rarely considered by respondents (31 and 35% of respondents, respectively). 98% of the respondents used crystalloids for fluid resuscitation. During the procedure, use of neuromuscular blockers, opioids and sedative agents were considered by respectively 84, 61 and 27% of the respondents. A very high level of agreement (10 [8-10], on a ten-points Likert-style scale) was reported concerning the expected impact of intraoperative anesthetic management on the primary function of grafts. Conclusions: Declared anesthetic practice appeared in accordance with guidelines concerning organ donor management in the ICU. Further studies are needed to evaluate the specific impact of intraoperative management during this procedure and thus the need for specific anesthetic guidelines.
MeSH term(s)	Anesthesia/methods ; Anesthesiologists/psychology ; Brain Death ; Clinical Competence ; France ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Humans ; Tissue and Organ Procurement/methods ; Tissue and Organ Procurement/organization & administration
Language	English
Publishing date	2019-06-15
Publishing country	England
Document type	Journal Article
ISSN	1471-2253
ISSN (online)	1471-2253
DOI	10.1186/s12871-019-0766-y
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Article ; Online: Morbidity and mortality related to pneumonia and TRACHEOBRONCHITIS in ICU after lung transplantation.

Tanaka, Sebastien / Geneve, Claire / Tebano, Gianpiero / Grall, Nathalie / Piednoir, Pascal / Bronchard, Régis / Godement, Mathieu / Atchade, Enora / Augustin, Pascal / Mal, Herve / Castier, Yves / Montravers, Philippe / Desmard, Mathieu

BMC pulmonary medicine

2018 Volume 18, Issue 1, Page(s) 43

Abstract: Background: Bacterial respiratory infections (BRI) are major complications contributing to increased morbidity and mortality after lung transplantation (LT). This study analyzed epidemiology and outcome of 175 consecutive patients developing BRI in ICU ... ...

Abstract	Background: Bacterial respiratory infections (BRI) are major complications contributing to increased morbidity and mortality after lung transplantation (LT). This study analyzed epidemiology and outcome of 175 consecutive patients developing BRI in ICU after LT between 2006 and 2012. Methods: Three situations were described: colonization determined in donors and recipients, pneumonia and tracheobronchitis during the first 28 postoperative days. Severity score, demographic, bacteriologic and outcome data were collected. Results: 26% of donors and 31% of recipients were colonized. 92% of recipients developed BRI, including at least one episode of pneumonia in 19% of recipients. Only 21% of recipients developed BRI with an organism cultured from the donor's samples, while 40% of recipients developed BRI with their own bacteria cultured before LT. Purulent sputum appears to be an important factor to discriminate tracheobronchitis from pneumonia. When compared to patients with tracheobronchitis, those with pneumonia had longer durations of mechanical ventilation (13 [3-27] vs 3 [29], p = 0.0005) and ICU stay (24 [16-34] vs 14 [9-22], p = 0.002). Pneumonia was associated with higher 28-day (11 (32%) vs 9 (7%), p = 0.0004) and one-year mortality rates (21 (61%) vs 24 (19%), p ≤ 0.0001). Conclusions: These data confirm the high frequency of BRI right from the early postoperative period and the poor prognosis of pneumonia after LT.
MeSH term(s)	Bacterial Infections/microbiology ; Bacterial Infections/mortality ; Bronchitis/etiology ; Bronchitis/microbiology ; Female ; France/epidemiology ; Hospital Mortality ; Humans ; Intensive Care Units ; Kaplan-Meier Estimate ; Length of Stay ; Logistic Models ; Lung Transplantation/adverse effects ; Lung Transplantation/mortality ; Male ; Middle Aged ; Morbidity ; Multivariate Analysis ; Pneumonia, Ventilator-Associated/microbiology ; Pneumonia, Ventilator-Associated/mortality ; Respiration, Artificial/adverse effects ; Retrospective Studies ; Time Factors
Language	English
Publishing date	2018-03-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2059871-3
ISSN	1471-2466 ; 1471-2466
ISSN (online)	1471-2466
ISSN	1471-2466
DOI	10.1186/s12890-018-0605-9
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Article ; Online: Risk factors for postoperative pneumonia after cardiac surgery and development of a preoperative risk score*.

Allou, Nicolas / Bronchard, Regis / Guglielminotti, Jean / Dilly, Marie Pierre / Provenchere, Sophie / Lucet, Jean Christophe / Laouénan, Cédric / Montravers, Philippe

Critical care medicine

2014 Volume 42, Issue 5, Page(s) 1150–1156

Abstract: Objectives: The aims of this study were, first, to identify risk factors for microbiology-proven postoperative pneumonia after cardiac surgery and, second, to develop and validate a preoperative scoring system for the risk of postoperative pneumonia.: ...

Abstract	Objectives: The aims of this study were, first, to identify risk factors for microbiology-proven postoperative pneumonia after cardiac surgery and, second, to develop and validate a preoperative scoring system for the risk of postoperative pneumonia. Design and setting: A single-center cohort study. Patients: All consecutive patients undergoing cardiac surgery between January 2006 and July 2011. Interventions: None. Measurements and main results: Multivariate analysis of risk factors for postoperative pneumonia was performed on data from patients operated between January 2006 and December 2008 (training set). External temporal validation was performed on data from patients operated between January 2009 and July 2011 (validation set). Preoperative variables identified in multivariate analysis of the training set were then used to develop a preoperative scoring system that was validated on the validation set. Postoperative pneumonia occurred in 174 of the 5,582 patients (3.1%; 95% CI, 2.7-3.6). Multivariate analysis identified four risk factors for postoperative pneumonia: age (odds ratio, 1.02; 95% CI, 1.01-1.03), chronic obstructive pulmonary disease (odds ratio, 2.97; 95% CI, 1.8-4.71), preoperative left ventricular ejection fraction (odds ratio, 0.98; 95% CI, 0.96-0.99), and the interaction between RBC transfusion during surgery and duration of cardiopulmonary bypass (odds ratio, 2.98; 95% CI, 1.96-4.54). A 6-point score including the three preoperative variables then defined two risk groups corresponding to postoperative pneumonia rates of 1.8% (score < 3) and 6.5% (score ≥ 3). Conclusion: Assessing preoperative risk factors for postoperative pneumonia with the proposed scoring system could help to implement a preventive policy in high-risk patients with a risk of postoperative pneumonia greater than 4% (i.e., patients with a score ≥ 3).
MeSH term(s)	Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass/adverse effects ; Cefamandole/therapeutic use ; Cohort Studies ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Pneumonia/microbiology ; Pneumonia/prevention & control ; Postoperative Complications/microbiology ; Postoperative Complications/prevention & control ; Risk Assessment/methods ; Risk Factors
Chemical Substances	Anti-Bacterial Agents ; Cefamandole (5CKP8C2LLI)
Language	English
Publishing date	2014-05
Publishing country	United States
Document type	Journal Article ; Observational Study ; Validation Studies
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000000143
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Article ; Online: Prospective assessment of hospital-acquired bloosdstream infections: how many may be preventable?

Bonnal, Christine / Mourvillier, Bruno / Bronchard, Régis / de Paula, Danielle / Armand-Lefevre, Laurence / L'heriteau, François / Quenon, Jean-Luc / Lucet, Jean-Christophe

Quality & safety in health care

2010 Volume 19, Issue 5, Page(s) e30

Abstract: Objective: To determine the proportion of preventable hospital-acquired bloodstream infections (HA-BSIs), the authors prospectively examined consecutive cases in a large university hospital over an 18-month period.: Patients and methods: Medical ... ...

Abstract	Objective: To determine the proportion of preventable hospital-acquired bloodstream infections (HA-BSIs), the authors prospectively examined consecutive cases in a large university hospital over an 18-month period. Patients and methods: Medical charts were assessed with the physician in charge of the patient within 4 days after HA-BSI diagnosis to determine whether the infection was healthcare-related. Preventability was assessed using a validated tool. Results of 378 HA-BSIs (incidence rate, 1.00 per 1000 patient-days), 341 were first HA-BSI episodes in a patient, and 272 (79.8%) were secondary to an identifiable source, of whom 196 (57.5%) were related to medical management. These 196 HA-BSIs were related to an invasive procedure (n=163), a non-invasive medical management (n=30) or both (n=3). Results: Of the 272 patients with HA-BSIs from identifiable sources, 55 (20.2%) had no underlying disease, 115 (42.3%) had an ultimately fatal underlying disease, 99 (36.4%) had a rapidly fatal disease, and three (1.1%) were not evaluated. Of the 196 iatrogenic HA-BSIs, 66 were considered preventable (most of them being related to an intravascular catheter), 84 were of uncertain preventability, and 46 were not preventable. In total, 66 of the 341 HA-BSIs (19.4%) were considered preventable, and 191 (56.0%) were not preventable. Conclusion: Although evaluation of the preventability of hospital-associated adverse events has been reported to be difficult and of limited reliability, our simple method may help to identify wards or HA-BSI types that warrant in-depth evaluation.
MeSH term(s)	Aged ; Aged, 80 and over ; Blood-Borne Pathogens/isolation & purification ; Cross Infection/epidemiology ; Cross Infection/prevention & control ; Female ; France/epidemiology ; Humans ; Male ; Medical Audit ; Middle Aged ; Prospective Studies
Language	English
Publishing date	2010-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2076251-3
ISSN	1475-3901 ; 0963-8172 ; 1475-3898
ISSN (online)	1475-3901
ISSN	0963-8172 ; 1475-3898
DOI	10.1136/qshc.2008.030296
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Zs.A 3754: Show issues

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Article ; Online: Emergence of imipenem-resistant gram-negative bacilli in intestinal flora of intensive care patients.

Armand-Lefèvre, Laurence / Angebault, Cécile / Barbier, François / Hamelet, Emilie / Defrance, Gilles / Ruppé, Etienne / Bronchard, Régis / Lepeule, Raphaël / Lucet, Jean-Christophe / El Mniai, Assiya / Wolff, Michel / Montravers, Philippe / Plésiat, Patrick / Andremont, Antoine

Antimicrobial agents and chemotherapy

2013 Volume 57, Issue 3, Page(s) 1488–1495

Abstract: Intestinal flora contains a reservoir of Gram-negative bacilli (GNB) resistant to cephalosporins, which are potentially pathogenic for intensive care unit (ICU) patients; this has led to increasing use of carbapenems. The emergence of carbapenem ... ...

Abstract	Intestinal flora contains a reservoir of Gram-negative bacilli (GNB) resistant to cephalosporins, which are potentially pathogenic for intensive care unit (ICU) patients; this has led to increasing use of carbapenems. The emergence of carbapenem resistance is a major concern for ICUs. Therefore, in this study, we aimed to assess the intestinal carriage of imipenem-resistant GNB (IR-GNB) in intensive care patients. For 6 months, 523 consecutive ICU patients were screened for rectal IR-GNB colonization upon admission and weekly thereafter. The phenotypes and genotypes of all isolates were determined, and a case control study was performed to identify risk factors for colonization. The IR-GNB colonization rate increased regularly from 5.6% after 1 week to 58.6% after 6 weeks in the ICU. In all, 56 IR-GNB strains were collected from 50 patients: 36 Pseudomonas aeruginosa strains, 12 Stenotrophomonas maltophilia strains, 6 Enterobacteriaceae strains, and 2 Acinetobacter baumannii strains. In P. aeruginosa, imipenem resistance was due to chromosomally encoded resistance (32 strains) or carbapenemase production (4 strains). In the Enterobacteriaceae strains, resistance was due to AmpC cephalosporinase and/or extended-spectrum β-lactamase production with porin loss. Genomic comparison showed that the strains were highly diverse, with 8 exceptions (4 VIM-2 carbapenemase-producing P. aeruginosa strains, 2 Klebsiella pneumoniae strains, and 2 S. maltophilia strains). The main risk factor for IR-GNB colonization was prior imipenem exposure. The odds ratio for colonization was already as high as 5.9 (95% confidence interval [95% CI], 1.5 to 25.7) after 1 to 3 days of exposure and increased to 7.8 (95% CI, 2.4 to 29.8) thereafter. In conclusion, even brief exposure to imipenem is a major risk factor for IR-GNB carriage.
MeSH term(s)	Acinetobacter baumannii/drug effects ; Acinetobacter baumannii/enzymology ; Acinetobacter baumannii/growth & development ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/adverse effects ; Bacterial Proteins/genetics ; Bacterial Proteins/metabolism ; Bacterial Typing Techniques ; Case-Control Studies ; Colon/microbiology ; Enterobacteriaceae/drug effects ; Enterobacteriaceae/enzymology ; Enterobacteriaceae/growth & development ; Female ; Gene Expression/drug effects ; Gram-Negative Bacterial Infections/drug therapy ; Gram-Negative Bacterial Infections/microbiology ; Humans ; Imipenem/administration & dosage ; Imipenem/adverse effects ; Intensive Care Units ; Male ; Middle Aged ; Pseudomonas aeruginosa/drug effects ; Pseudomonas aeruginosa/enzymology ; Pseudomonas aeruginosa/growth & development ; Stenotrophomonas maltophilia/drug effects ; Stenotrophomonas maltophilia/enzymology ; Stenotrophomonas maltophilia/growth & development ; beta-Lactam Resistance/drug effects ; beta-Lactamases/genetics ; beta-Lactamases/metabolism
Chemical Substances	Anti-Bacterial Agents ; Bacterial Proteins ; Imipenem (71OTZ9ZE0A) ; beta-Lactamases (EC 3.5.2.6) ; carbapenemase (EC 3.5.2.6)
Language	English
Publishing date	2013-01-14
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	217602-6
ISSN	1098-6596 ; 0066-4804
ISSN (online)	1098-6596
ISSN	0066-4804
DOI	10.1128/AAC.01823-12
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Article ; Online: Pseudomonas aeruginosa post-operative peritonitis: clinical features, risk factors, and prognosis.

Augustin, Pascal / Tran-Dinh, Alexy / Valin, Nadia / Desmard, Mathieu / Crevecoeur, Marie Adeline / Muller-Serieys, Claudette / Woerther, Paul-Louis / Marmuse, Jean-Pierre / Bronchard, Regis / Montravers, Philippe

Surgical infections

2013 Volume 14, Issue 3, Page(s) 297–303

Abstract: Background: Postoperative peritonitis (PP) is associated with a high rate of multi-drug-resistant micro-organisms. The role of Pseudomonas aeruginosa in this condition has never been assessed. We evaluated the risk factors and prognosis for PP caused by ...

Abstract	Background: Postoperative peritonitis (PP) is associated with a high rate of multi-drug-resistant micro-organisms. The role of Pseudomonas aeruginosa in this condition has never been assessed. We evaluated the risk factors and prognosis for PP caused by P. aeruginosa. Methods: Patients hospitalized in the intensive care unit (ICU) after re-operation for PP were identified prospectively. Analyses were performed retrospectively. Specific risk factors were investigated by comparing P. aeruginosa PP with PP having other causes. The main outcome endpoint was death in the hospital. Results: We found 55 P. aeruginosa PP among the 349 cases of PP (16%) in the ICU over 14 years. Factors associated with the presence of P. aeruginosa in peritoneal fluid culture were Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.02-1.09; p=0.004) and respiratory failure (OR 2.3; 95% CI 1.26-4.16; p=0.006). These criteria performed poorly in predicting P. aeruginosa PP. Such infections were associated with a higher hospital mortality rate, but not after adjustment for the severity score. Adequate antibiotic therapy comprising two antibiotics effective against P. aeruginosa was associated with a lower mortality rate for P. aeruginosa PP in the ICU. Conclusion: The prevalence of P. aeruginosa PP is not high. Risk factors do not allow accurate prediction of the infection. Our data suggest two drugs effective against P. aeruginosa should be considered for treating these infections.
MeSH term(s)	Aged ; Aged, 80 and over ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Peritonitis/diagnosis ; Peritonitis/microbiology ; Postoperative Complications/diagnosis ; Postoperative Complications/microbiology ; Prevalence ; Prognosis ; Pseudomonas Infections/diagnosis ; Pseudomonas Infections/microbiology ; Pseudomonas aeruginosa/isolation & purification ; Retrospective Studies ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	2013-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2012.084
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Article ; Online: Rapid adaptation of antibiotic therapy for community-acquired peritonitis using direct cultures on antibiotic agar plates: pilot study.

Lasocki, Sigismond / Skurnik, David / Muller-Serieys, Claudette / Bronchard, Regis / Marcel, Candice / Marmuse, Jean-Pierre / Montravers, Philippe / Andremont, Antoine

Surgical infections

2009 Volume 10, Issue 4, Page(s) 333–338

Abstract: Background: Treatment of peritonitis requires prompt surgery and antibiotic therapy. It usually takes two or three days to obtain definitive results of peritoneal cultures and to adapt empirical antibiotic therapy. We assessed the potential time gain ... ...

Abstract	Background: Treatment of peritonitis requires prompt surgery and antibiotic therapy. It usually takes two or three days to obtain definitive results of peritoneal cultures and to adapt empirical antibiotic therapy. We assessed the potential time gain associated with direct culture of peritoneal samples on antibiotic agar (AA). Methods: Peritoneal samples from 31 consecutive patients undergoing surgery for suspected community-acquired peritonitis were cultured according to the standard method and on AA containing one of the following five regimens: amoxicillin/clavulanic acid + gentamicin, ticarcillin/clavulanic acid + gentamicin, cefotaxime +metronidazole, piperacillin/tazobactam, or ertapenem. We compared the treatment modifications made by physicians aware only of the results of the standard method with the modifications the AA method would have indicated. Results: Fewer isolates were identified by direct culture on AA than by the standard method (17 vs. 45; p = 0.0001), but definitive results were obtained much more rapidly (median 1 [range 1-3] days vs. 3 [range 2-7] days; p < 0.0001). Antibiotic regimens were changed for 14 patients on the basis of the results of the standard method (broader antibiotic spectrum and narrower spectrum in seven patients each). With the AA method, these changes could have been indicated after a median of 1 (range 1-2) days instead of 4 (range 1-11) days (p = 0.0006). The AA method missed only one resistant bacterial strain and isolated nine strains not detected by the standard method, including an extended-spectrum beta-lactamase-producing Escherichia coli. A complicated outcome was more frequent in patients having isolates found with the AA but not the standard method (86% vs. 21%; p = 0.003). Conclusion: Use of the AA method for culture of peritoneal samples from patients with community-acquired peritonitis speeds appropriate adaptation of antibiotic therapy and warrants further investigation.
MeSH term(s)	Adult ; Agar ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Bacteria/drug effects ; Bacteria/growth & development ; Bacteria/isolation & purification ; Community-Acquired Infections/drug therapy ; Culture Media/chemistry ; Female ; Humans ; Male ; Microbial Sensitivity Tests/methods ; Middle Aged ; Peritonitis/drug therapy ; Pilot Projects ; Time Factors ; Young Adult
Chemical Substances	Anti-Bacterial Agents ; Culture Media ; Agar (9002-18-0)
Language	English
Publishing date	2009-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2008.095
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Zs.A 5617: Show issues

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Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

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