eP795 Management and day-10 outcome of 494 bacteraemias in 23 northern France hospitals S. Alfandari1, P. Cabaret2, S. Nguyen3, D. Descamps3, A. Vachée4, C. Cattoen5, N. Van Grunderbeeck6 on behalf of the ARMEDA network Correspondance: [email protected] 1CH Tourcoing, 2CH Lomme, 3CH Béthune, 4CH Roubaix, 5CH Valenciennes, 6CH Lens

Introduction and Purpose Methods Conclusions Aknowledgments • Prospective multicenter observationnal survey in oct/nov 2011 • Good motivational tool for AB management teams Participating hospitals • Bacteraemias are severe infections CH St Vincent (N Baclet) • Positive points CH Armentieres (C Bonenfant, C Canevet) • Ethics committee and French privacy authority approval CH Arras (C Vandenbussche) CHRU Lille medecine geriatrique (B Corroyer) • Antibiotics (AB) are urgent but with a risk of AB overuse Hôpital Privé La Louvière (F Parmentier) Hospital recruited throught the ARMEDA AB management team network – Acceptable adequacy of empirical therapy: ~75% CH Béthune (D Descamps, S N’Guyen) • Fondation Hopale (C Carpentier, V Dacquet) CH Lens (L Tronchon, N Vangrunderbeeck) • Good topic to introduce /promote antimicrobial stewardship teams CH Sambre Avesnois (T Levent) Inclusion of 30 (all if <30) consecutive positive blood cultures – Very high adequacy after antibiogram reception: 96% CH Boulogne/mer (G Brunin) • CH Calais (S Joron, JM Pannecouck) CH Roubaix (C Laurens, A Vachée) • Aims of the study: Standardized data sheet – No carbapenems in top 10 empirical/documented AB CH Cambrai (B Dumoulard) CH St Philibert (P Cabaret, V Leclercq) • CH Charleville-Mézières (J Reveil) CH Saint Quentin (Y Douadi, H Bentayeb) • Evaluate AB management of bacteraemias in hospitals Online collection with real time analysis of comparative data • Limits CH Douai (C Debruille, X Lemaire) Polyclinique du Parc - Saint Saulve (T Levent ) • CH Dunkerque (I Joly) CH Seclin (C Rolland) • Describe the currrent microbial ecology Main criteria: % of patients with at least 1 AB active against pathogen • Wide variation in patient accrual/center (4-52) CH Hazebrouck (C Begonlours, RParsy) CH Tourcoing (S Alfandari) • Polyclinique Henin Beaumont (T Lestienne) Clin Victoire, Tourcoing (L Paris) • Estimate short term outcome of bacteriemias CH Valenciennes (C Cattoen, MC Chopin, N Ettahar) • Follow up limited to 10 days IT management • Provide regional benchmarking for AB good practices • Future priority: E. Santerne • improve deescalation/streamlining therapy (49%) Results

Patients 494 pathogen positive blood cultures 524 pathogens Antibiotics Antibiotic adequacy Micro-organisms N % % AB resistance Wards • 633 patients from E. coli 179 36% 12 (6,7%) Empirical therapy N=722 Documented therapy N=560 • Empirical therapy – 18 public hospitals Oncology 8 S. aureus 80 16% 15 (19%) Ceftriaxone 179 Ceftriaxone 115 – 4 non profit hospitals Klebsiella, Enterobacter, Serratia 63 •75% (370/494) with 1+ active drug Haematology 8 13% 14 (22,2%) Coamoxiclav 98 Coamoxiclav 63 – 3 private hospitals Streptococci 43 9% Gentamicin 61 Piperacillin+Tazobactam 41 • Documented therapy Infectious dis. 9 Coagulase negative staph 39 8% Ofloxacin 36 •Excluding death/transfert before results • Age: 68,2 +/- 18,3 Pediatrics 18 Piperacillin+Tazobactam 54 Other GNB 32 6% 0 Amikacine 51 Amoxicillin 32 available • Weight: 70,5 +/- 25 kg Intensive care 68 Pneumococcus 22 4% Metronidazole 37 Vancomycin 32 • 96% (457/475) with 1+ active drug (75%) • Serum creatinine Surgery 95 Anaerobes 19 4% Cefotaxime 31 Gentamicin 30 •10 without adaptation/results •13,7 +/- 12,2 mg/l Medicine Enterococci 18 3% 0 Cefotaxime 23 288 Vancomycine 30 •6 without any AB P. aeruginosa 10 2% 2 (20%) • H/F: 1.3 Levofloxacin 29 Metronidazole 21 Candida 8 2% Amikacin 20 Source Ofloxacin 29 Treatment quality Other 11 2% Other 147 Contaminants Other 123 Urinary tract 140 Polymicrobial bacteraemias = 31 (6,2%) • Intervention of the AB team: 36% • 140 contaminants Digestive tract 82 Pneumonia 73 AB resistance: extended spectrum b-lactamases (GNB), methicilline (SA), glycopeptides (enterococci), CAZ or IMP (Pseudomonas) – 118 coagulase negative Unknown 63 • Compliance to local guidelines: 77% staph Catheter 49 Skin/soft tissue 41 Healthcare associated bacteraemias Outcome: d10 mortality – 11 (7.9%) with Bone/joint 15 • Time to 1st active AB/blood culture drawn unnecessary AB Endocarditis 11 HAB (other hospital) 15 12,1% deaths (n=60): • Mean: 0.93 +/- 0.97d Central nervous system 5 • Median: 0d Other 17 Rehab/LTC/nursing home 41 – 32 (22,5%) if shock/SS – 25 (7,1%) w/o shock/SS • Deescalation therapy (when possible) HAB (same hospital) 162 143 (29%) patients with 60% bacteraemia linked – Perfect (narrowest spectrum AB): 49% severe sepsis or shock at Community acquired 276 – Partial: 13% presentation

23rd European Congress of Clinical Microbiology and Infectious Diseases, Berlin 27–30 April 2013