Advertisement

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

Abstract

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.

Keywords

Multidrug-resistant bacteria Infection control Colonization Prevention Antimicrobials Intensive care Sepsis 

Notes

Acknowledgements

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.

Funding

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)

References

  1. 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
  2. 2.
    Poulakou G, Matthaiou DK, Bassetti M, Erdem H, Dimopoulos G, Curcio DJ et al (2017) “Salvage treatment” for infections by extensively- and pan-drug-resistant pathogens is common and often sub-optimal. Intensive Care Med 43:1164–1166CrossRefGoogle Scholar
  3. 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. 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
  5. 5.
    Rello J, Lagunes L, Alves J, Pulcini C, Conway-Morris A, Alp E et al (2018) TOp TEn resistant microorganisms at intensive care unit: a 2018 global expert survey (TOTEM study protocol). J Emerg Crit Care Med 2:6–6CrossRefGoogle Scholar
  6. 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. 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
  8. 8.
    Geisinger E, Isberg RR (2017) Interplay between antibiotic resistance and virulence during disease promoted by multidrug-resistant bacteria. J Infect Dis 215:S9–S17CrossRefGoogle Scholar
  9. 9.
    Nelson RE, Slayton RB, Stevens VW, Jones MM, Khader K, Rubin MA et al (2017) Attributable mortality of healthcare-associated infections due to multidrug-resistant gram-negative bacteria and methicillin-resistant staphylococcus aureus. Infect Control Hosp Epidemiol 38:848–856CrossRefGoogle Scholar
  10. 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. 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
  12. 12.
    Pogue JM, Bonomo RA, Kaye KS (2019) Ceftazidime/avibactam, Meropenem/vaborbactam or both? Clinical and formulary considerations. Clin Infect Dis 68:519–524CrossRefGoogle Scholar
  13. 13.
    Paterson DL, Harris PNA (2015) Editorial Commentary : the new Acinetobacter equation: Hypervirulence plus antibiotic resistance equals big trouble. Clin Infect Dis 61:155–156CrossRefGoogle Scholar
  14. 14.
    Kollef MH, Burnham CAD (2017) Ventilator-associated pneumonia: the role of emerging diagnostic technologies. Semin Respir Crit Care Med 38:253–263CrossRefGoogle Scholar
  15. 15.
    Edmiston CE, Garcia R, Barnden M, DeBaun B, Johnson HB (2018) Rapid diagnostics for bloodstream infections: a primer for infection preventionists. Am J Infect Control 46:1060–1068CrossRefGoogle Scholar
  16. 16.
    Health care-associated infections FACT SHEET. http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf. Accessed 3 March 2019
  17. 17.
    Talaat M, El-Shokry M, El-Kholy J, Ismail G, Kotb S, Hafez S et al (2016) National surveillance of health care–associated infections in Egypt: developing a sustainable program in a resource-limited country. Am J Infect Control 44:1296–1301CrossRefGoogle Scholar
  18. 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
  19. 19.
    Dondorp AM, Limmathurotsakul D, Ashley EA (2018) What’s wrong in the control of antimicrobial resistance in critically ill patients from low- and middle-income countries? Intensive Care Med 44:79–82CrossRefGoogle Scholar
  20. 20.
    Alp E, Damani N (2015) Healthcare-associated infections in intensive care units: epidemiology and infection control in low-to-middle income countries. J Infect Dev Ctries 9:1040–1045CrossRefGoogle Scholar
  21. 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. 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
  23. 23.
    Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD et al (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA 302:2323–2329CrossRefGoogle Scholar
  24. 24.
    Johnson AP (2011) Methicillin-resistant Staphylococcus aureus: the European landscape. J Antimicrob Chemother 66:iv43–iv48CrossRefGoogle Scholar
  25. 25.
    Klein EY, Mojica N, Jiang W, Cosgrove SE, Septimus E, Morgan DJ et al (2017) Trends in methicillin-resistant Staphylococcus aureus hospitalizations in the United States, 2010-2014. Clin Infect Dis 65:1921–1923CrossRefGoogle Scholar

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

Personalised recommendations