Antimicrobial Stewardship in Hematological Patients at the intensive care unit: a global cross-sectional survey from the Nine-i Investigators Network
A global cross-sectional survey was performed to gather data on the current treatment of infections caused by multidrug-resistant (MDR) bacteria among hematological patients admitted to ICUs worldwide. The survey was performed in April 2019 using an electronic platform (SurveyMonkey®) being distributed among 83 physicians and completed by 48 (57.8%) responders. ESBL Enterobacteriaceae, carbapenem-resistant K. pneumoniae and carbapenem-resistant P. aeruginosa were the main concerns. Previous MDR infection (34% of responders), MDR colonization (20%) and previous antibiotic exposure within the last 3 months (20.5%) were considered the most relevant risk factors of bloodstream infection (BSI) due to MDR bacteria. In 48.8% of the ICUs, there was no antimicrobial stewardship (AMS) team focused on hematological patients. Updates on local epidemiology of MDR pathogens were provided in 98% of the centers, using phone or verbal communications (56.1% and 53.7%, respectively). In presence of febrile neutropenia, initial therapy consisted of anti-Gram-negative plus anti-Gram-positive antibiotics for 41% of participants. Antibiotic de-escalation and/or discontinuation of therapy were considered as a promising strategy for the prevention of MDR development (32.4%). Factors associated with antibiotic de-escalation were clinical improvement (43.6%) and neutrophil count recovery (12.8%). Infectious Disease consultation and AMS interventions were not determining factors for de-escalation decisions (more than 50% of responders). Infection control and educational programs were valued as necessary measures for implementation by ICU practitioners. These findings should guide future efforts on collaborative team working, improving compliance with adequate treatment protocols, implementing antimicrobial stewardship programs in critically ill hematological patients, and educational activities.
KeywordsMultidrug-resistant (MDR) bacteria Difficult to treat organisms Antimicrobial de-escalation (ADE) Antimicrobial stewardship (AMS) Pneumonia Febrile neutropenia (FN) Intensive care unit Septic shock
We appreciate comments in the design from the following: Carolina Garcia-Vidal (Barcelona, Spain), M. Santos Lurdes (Porto, Portugal), Pedro Palma-Martins (Porto, Portugal). The study was developed in part of an Observership Programme, ESCMID, Basel; Switzerland (Cristina Sarda).
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 the Observership Programme of ESCMID, Basel, Switzerland (CS).
Compliance with ethical standards
Conflict of interest
Jordi Rello served a consultant or in the speakers bureau for Merck, Anchoagen, Pfizer, ROCHE and in the speakers bureau for Pfizer. Other authors have no conflicts of interest to declare.
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