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; Temocillin Greater Paris Study Group

doi:10.1093/jacamr/dlac132

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

JAC Antimicrob Resist. 2022 Dec 29;5(1):dlac132. doi: 10.1093/jacamr/dlac132. eCollection 2023 Feb.

Authors

Collaborators

Affiliations

¹ Infectious Disease Department, Raymond-Poincaré Hospital, AP-HP, Université Paris Saclay, Garches, France.
² Pharmacy Department, Cochin Hospital, AP-HP, Centre-Université Paris Cité, Paris, France.
³ Pharmacy Department, Bichat Hospital, AP-HP, Nord-Université Paris Cité, Paris, France.
⁴ Pharmacy Department, Saint-Louis Hospital, AP-HP, Nord-Université Paris Cité, Paris, France.
⁵ Internal Medicine Department, Beaujon Hospital, AP-HP, Nord-Université Paris Cité, Clichy, France.
⁶ Pharmacy Department, Saint-Antoine Hospital, AP-HP, Sorbonne Université, Paris, France.
⁷ Pharmacy Department, Henri-Mondor Hospital, AP-HP, HU Henri Mondor, Creteil, France.
⁸ Pharmacy Department, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, Paris, France.
⁹ Pharmacy Department, Tenon Hospital, AP-HP, Sorbonne Université, Paris, France.
¹⁰ Tropical and Infectious Disease Department, Bicêtre Hospital, AP-HP, Université Paris Saclay, Kremlin-Bicêtre, France.
¹¹ Pharmacy Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France.
¹² Infectious Disease Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France.
¹³ Pharmacy Department, Raymond-Poincaré Hospital, AP-HP, Université Paris Saclay, Garches, France.

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.