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

Rello, Jordi; Eshwara, Vandana; Conway-Morris, Andrew; Lagunes, Leonel; Alves, Joana; Alp, Emine; Zhang, Zhongheng; Mer, Mervyn; Luna, C.; Reina, R.; Dobrevska, R.; Deng, H.; Leiqing, L.; Liu, L.; Wang, D.; Yuetian, Y.; Zhang, G.; Zhang, Zh; Zheng, C.; Del Rio, G.; Rojas, J.; Amare, D.; Alfandri, S.; Argemi, X.; Kernies, S.; Lesprit, P.; Arvanitik, K.; Papanikolaou, M.; Tsigou, E.; Soultati, I; Platsouka, E.; Katsiari, M.; Nikolaou, C.; Tsiodras, S.; Antonelli, M.; Cascio, A.; Dellamonica, J.; DiPascale, G.; Garofalo, E.; Girardis, M.; Leone, D.; Vandana, K.; Kaniyarakkal, V; Munim, F.; Nath, S.; Patil, S.; Suchitra, U.; Yahav, D.; Misango, D.; Gecaj-Gashi, A.; Rotimi, V; Aguilar, D.; Araujo-Melendez, J.; Franco-Zendejas, R.; Lagunes, L.; Lemus, J.; Martinez D E, Perales; Chavez M, Rivera; Schouten, J.; Khamis, F.; Nizamuddin, S.; Santos, L.; Santos-Ribeiro, E.; Alekar, S.; Baker, D.; Ballot, D.; Black, V; Bhamjee, S.; Brannigan, L.; Hunt, I.; Kotze, J.; Lowman, W.; Levy, B.; Mer, M.; Morar, R.; Michell, W.; Nana, T.; Pahad, H.; Tsai, M.; Schleicher, G.; Shaddock, E.; Shoul, E.; Smith, C.; Richards, G.; Van der Merwe, L.; Welkovics, N.; Borges, M.; Diaz, E.; Garnacho-Montero, J.; Maseda, E.; Manez, R.; Rello, J.; Samso, E.; Serrano, R.; Sole-Violan, J.; Vidaur, L.; Zaragoza, R.; Wongsurakiat, P.; Abravci, N.; Akbudak, I; Akkoyunlu, YASEMİN; Altindis, M.; DCelebi, Aydin; Emel, A.; Alp, E.; Erdem, H.; Gulden, E.; Guner, R.; Kizmaz, Y.; Yalcin, A.; Kepenek, E.; Sener, A.; Tekin, R.; Tulek, N.; Ulu, Unuvar; Miftode, E.; Buckley, J.; Conway-Morris, A.; Dunn, M.; Hall, A.; Hobrok, M.; Felton, T.; Fletcher, S.; Marshall, B.; McConnell, H.; Mckee, R.; McAuley, D.; Mcfie, C.; Morton, B.; Naisbitt, J.; Rooney, K.; Szakmany, T.; Yates, B.; Zochios, V; Wunderink, Richard; Von der Osten, J.

doi:10.1007/s10096-019-03530-1

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

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Rello J., Eshwara V. K., Conway-Morris A., Lagunes L., Alves J., Alp E., ...More

EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, vol.38, no.7, pp.1235-1240, 2019 (SCI-Expanded)

Publication Type: Article / Article
Volume: 38 Issue: 7
Publication Date: 2019
Doi Number: 10.1007/s10096-019-03530-1
Journal Name: EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES
Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
Page Numbers: pp.1235-1240
Keywords: Multidrug-resistant bacteria, Infection control, Colonization, Prevention, Antimicrobials, Intensive care, Sepsis, CARE-ASSOCIATED INFECTIONS, ATTRIBUTABLE MORTALITY, ANTIBIOTIC-RESISTANCE, PREVALENCE, PNEUMONIA, UNITS
Bezmialem Vakıf University Affiliated: Yes

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.