Perceived differences between intensivists and infectious diseases consultants facing antimicrobial resistance: a global cross-sectional survey

  • Jordi RelloEmail author
  • Vandana Kalwaje Eshwara
  • Andrew Conway-Morris
  • Leonel Lagunes
  • Joana Alves
  • Emine Alp
  • Zhongheng Zhang
  • Mervyn Mer
  • TOTEM Study Investigators
Original Article


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.


Multidrug-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

Not required.

Supplementary material

10096_2019_3530_MOESM1_ESM.docx (28 kb)
ESM 1 (DOCX 27 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.CIBER de Enfermedades RespiratoriasCIBERESBarcelonaSpain
  2. 2.Vall d’Hebron Institut of Research (VHIR)BarcelonaSpain
  3. 3.Department of Microbiology, Kasturba Medical CollegeManipal Academy of Higher EducationManipalIndia
  4. 4.Division of Anaesthesia, Department of MedicineUniversity of CambridgeCambridgeUK
  5. 5.Intensive Care DepartmentSan Luis PotosiMexico
  6. 6.Infectious DiseasesBraga Hospital CenterBragaPortugal
  7. 7.Department of Infectious Diseases and Clinical Microbiology, Medical FacultyErciyes UniversityKayseriTurkey
  8. 8.Department of Emergency Medicine, Sir Run-Run Shaw HospitalZhejiang University School of MedicineHangzhouChina
  9. 9.Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Heath SciencesUniversity of the WitwatersrandJohannesburgSouth Africa

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