Real-life temocillin use in Greater Paris area, effectiveness and risk factors for failure in infections caused by ESBL-producing Enterobacterales: a multicentre retrospective study
Aurélien Dinh, Clara Duran, Simrandeep Singh, Chloé Tesmoingt, Laura Bouabdallah, Antoine Hamon, Marie Antignac, Clément Ourghanlian, Marie-Caroline Loustalot, Jean Baptiste Pain, Benjamin Wyplosz, Helga Junot, Alexandre Bleibtreu, Hugues Michelon, The Temocillin Greater Paris Study Group, Aurélien Dinh, Clara Duran, Hugues Michelon, Rui Batista, Simrandeep Singh, Laurène Deconinck, Chloé Tesmoingt, Laura Bouadballah, Matthieu Lafaurie, Sophie Touratier, Victoire de Lastours, Antoine Hamon, Marie Antignac, Jérôme Pacanowski, Clément Ourghanlian, R. Lepeule, David Lebeaux, Marie-Caroline Loustalot, Ruxandra Câlin, Jean Baptiste Pain, Benjamin Wyplosz, Alexandre Bleibtreu, Helga Junot
Abstract
Abstract Background Temocillin is a β-lactam that is not hydrolysed by ESBLs Objectives To describe the real-life use of temocillin, to assess its effectiveness in infections caused by ESBL-producing Enterobacterales, and to identify risk factors for treatment failure. Methods Retrospective multicentric study in eight tertiary care hospitals in the Greater Paris area, including patients who received at least one dose of temocillin for ESBL infections from 1 January to 31 December 2018. Failure was a composite criterion defined within 28 day follow-up by persistence or reappearance of signs of infection, and/or switch to suppressive antibiotic treatment and/or death from infection. A logistic regression with univariable and multivariable analysis was performed to identify risks associated with failure. Results Data on 130 infection episodes were collected; 113 were due to ESBL-producing Enterobacterales. Mean age was 65.2 ± 15.7 years and 68.1% patients were male. Indications were mostly urinary tract infections (UTIs) (85.8%), bloodstream infections (11.5%), respiratory tract infections (RTIs) (3.5%) and intra-abdominal infections (3.5%). Bacteria involved were Escherichia coli (49.6%), Klebsiella pneumoniae (44.2%) and Enterobacter cloacae (8.8%). Polymicrobial infections occurred in 23.0% of cases. Temocillin was mostly used in monotherapy (102/113, 90.3%). Failure was found in 13.3% of cases. Risk factors for failure in multivariable analysis were: RTI (aOR 23.3, 95% CI 1.5–358.2) and neurological disease (aOR 5.3, 95% CI 1.5–18.6). Conclusions The main use of temocillin was UTI due to ESBL-producing E. coli and K. pneumoniae, with a favourable clinical outcome. The main risk factor for failure was neurological disease.