A global priority list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care: a prioritization exercise based on multi-criteria decision analysis.
Kalwaje Eshwara, Vandana
Wunderink, Richard G
Rojas, Jose Nicolas
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
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Rello, J., Kalwaje Eshwara, V., Lagunes, L., Alves, J., Wunderink, R. G., Conway-Morris, A., Rojas, J. N., 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.. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 38 (2), 319-323. https://doi.org/10.1007/s10096-018-3428-y
Purpose: The World Health Organization (WHO) proposed a global priority pathogen list (PPL) of multi32 drug resistant (MDR) bacteria. Our current objective was to provide global expert ranking of the most serious multi-drug resistant (MDR) bacteria present at intensive care units (ICU) that have become a threat in clinical practice. Methods: A proposal addressing a pathogens priority list (PPL) for ICU, arising from the WHO Global PPL was developed. Based on the supporting data, the pathogens were grouped in three priority tiers: Critical, high and medium. A multi-criteria decision analyses (MCDA) was used to identify the priority tiers. Results: After MCDA analysis, mortality, treatability and cost of therapy were of highest concern (scores of 19/20, 19/20 and 15/20, respectively) while dealing with PPL, followed by healthcare burden and resistance prevalence. Carbapenen-resistant (CR) Acinetobacter baumannii, Carbapenemase expressing Klebsiella pneumoniae (KPC) and MDR Pseudomonas aeruginosa were identified as critical organisms. High risk organisms were represented by CR Pseudomonas aeruginosa, Methicillin resistant Staphylococcus aureus, and Extended Spectrum Beta lactamase(ESBL) Enterobacteriaceae. Finally, ESBL Serratia marcescens, Vancomycin-resistant Enterococci and TMP-SMX resistant Stenotrophomonas maltophilia were identified as medium priority. Conclusions: We conclude that education, investigation, funding and development of new antimicrobials for ICU organisms should focus on Carbapenem-resistant Gram negative organisms.
Humans, Bacteria, Cross Infection, Anti-Bacterial Agents, Infection Control, Drug Resistance, Multiple, Bacterial, Decision Support Techniques, Intensive Care Units, Practice Guidelines as Topic
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.
Wellcome Trust (205214/Z/16/Z)
External DOI: https://doi.org/10.1007/s10096-018-3428-y
This record's URL: https://www.repository.cam.ac.uk/handle/1810/286801