Perceived differences between intensivists and infectious diseases consultants facing antimicrobial resistance: a global cross-sectional survey
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To identify differences in perception on multi-drug-resistant (MDR) organisms and their management at intensive care units (ICU). A cross-sectional survey was conducted. A proposal addressing a pathogen priority list (PPL) for ICU, arising from the TOTEM study, was compared with a sample of global experts in infections in critically ill patients. The survey was responded by 129 experts. Globally, ESBL Enterobacteriaceae, followed by carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae, were the main concerns. Some differences in opinion were identified between 63 (49%) ICU physicians (ICU/anesthesiology) and 43 (33%) infectious disease consultants (ID physicians/microbiologists). The pathogens most concerning in the ICU for intensivists were ESBL Enterobacteriaceae (38%) versus carbapenem-resistant A. baumannii (48.3%) for ID consultants, (p < 0.05). Increasing number of ID consultants over intensivists (26% vs 14%) reported difficulty in choosing initial therapy for carbapenem-resistant A. baumannii. For intensivists, the urgent measures to limit development of antibiotic resistance were headed by cohort measures (26.3%) versus increasing nurse/patient ratio (32.5%) for ID consultants, (p < 0.05). Regarding effectiveness to prevent MDR development and spread, education programs (42.4%) were the priority for intensivists versus external consultation (35.7%) for ID consultants. Finally, both groups agreed that carbapenem resistance was the most pressing concern (> 70%) regarding emerging resistance. Differences in priorities regarding organisms, infection control practices, and educational priorities were visualized between ID/clinical microbiologists and ICU/anesthesiologists. Multi-disciplinary collaboration is required to achieve best care for ICU patients with severe infections.
KeywordsMultidrug-resistant bacteria Infection control Colonization Prevention Antimicrobials Intensive care Sepsis
The study was performed as part of an Observership Grant (Vandana KE) from the European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland. We appreciate comments in the design from Nieves Larrosa, Barcelona, Spain. The study was funded in part by Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. We thank the study group investigators for their valuable support.
The study was funded in part by Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain and Observership Programme from ESCMID, Basel, Switzerland.
Compliance with ethical standards
Conflicts of interest
Dr. Rello served in the speaker’s bureau or consultant for Pfizer, Anchoagen, ROCHE. The remaining authors have no conflicts of interest to declare.
Ethical approval/informed consent
- 1.WHO (2017) Prioritization of pathogens to guide discovery, research and development of new antibiotics for drug resistant bacterial infections, including tuberculosis. Essent Med Heal Prod 88. doi:WHO reference number: WHO/EMP/IAU/2017.12Google Scholar
- 3.Rello J, Kalwaje Eshwara V, Lagunes L, Alves J, Wunderink RG, Conway-Morris A et al (2019) A global priority list of the TOp TEn resistant microorganisms (TOTEM) study at intensive care: a prioritization exercise based on multi-criteria decision analysis. Eur J Clin Microbiol Infect Dis 38:319–323CrossRefGoogle Scholar
- 4.Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG et al (2012) Multidrug-resistant, extensively drug-resistant and pandrugresistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18:268–281CrossRefGoogle Scholar
- 6.Borgatta B, Gattarello S, Mazo CA, Imbiscuso AT, Larrosa MN, Lujan M et al (2017) The clinical significance of pneumonia in patients with respiratory specimens harbouring multidrug-resistant Pseudomonas aeruginosa: a 5-year retrospective study following 5667 patients in four general ICUs. Eur J Clin Microbiol Infect Dis 36:2155–2163CrossRefGoogle Scholar
- 7.Grundmann H, Glasner C, Albiger B, Aanensen DM, Tomlinson CT, Andrasević AT et al (2017) Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study. Lancet Infect Dis 17:153–163CrossRefGoogle Scholar
- 10.Adrie C, Garrouste-Orgeas M, Ibn Essaied W, Schwebel C, Darmon M, Mourvillier B et al (2017) Attributable mortality of ICU-acquired bloodstream infections: impact of the source, causative micro-organism, resistance profile and antimicrobial therapy. J Inf Secur 74:131–141Google Scholar
- 11.Zhang Y, Chen X-L, Huang A-W, Liu S-L, Liu W-J, Zhang N et al (2016) Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies. Emerg Microbes Infect 5:e27–e27Google Scholar
- 16.Health care-associated infections FACT SHEET. http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf. Accessed 3 March 2019
- 18.Lim C, Takahashi E, Hongsuwan M, Wuthiekanun V, Thamlikitkul V, Hinjoy S et al (2016) Epidemiology and burden of multidrug-resistant bacterial infection in a developing country. Elife 5. https://doi.org/10.7554/eLife.18082
- 21.Iwuafor AA, Ogunsola FT, Oladele RO, Oduyebo OO, Desalu I, Egwuatu CC et al (2016) Incidence, clinical outcome and risk factors of intensive care unit infections in the Lagos University teaching hospital (LUTH), Lagos, Nigeria. PLoS One 11:e0165242. https://doi.org/10.1371/journal.pone.0165242 CrossRefGoogle Scholar
- 22.Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, NicolasChanoin MH et al (1998) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European prevalence of infection in intensive care (EPIC) study. EPIC international advisory committee. JAMA 274:639–644CrossRefGoogle Scholar