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

Accepted version
Peer-reviewed

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Type

Article

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Authors

Kalwaje Eshwara, Vandana 
Conway-Morris, Andrew 
Lagunes, Leonel 
Alves, Joana 

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.

Description

Keywords

Antimicrobials, Colonization, Infection control, Intensive care, Multidrug-resistant bacteria, Prevention, Sepsis, Anti-Bacterial Agents, Carbapenems, Cohort Studies, Communicable Diseases, Critical Care, Cross-Sectional Studies, Drug Resistance, Multiple, Bacterial, Enterobacteriaceae, Global Health, Humans, Infection Control, Intensive Care Units, Microbial Sensitivity Tests, Physicians

Journal Title

Eur J Clin Microbiol Infect Dis

Conference Name

Journal ISSN

0934-9723
1435-4373

Volume Title

38

Publisher

Springer Science and Business Media LLC
Sponsorship
Wellcome Trust (205214/Z/16/Z)
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