A global priority list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care: a prioritization exercise based on multi-criteria decision analysis.

Authors
Kalwaje Eshwara, Vandana 
Lagunes, Leo 
Alves, Joana 
Wunderink, Richard G 

Loading...
Thumbnail Image
Type
Article
Change log
Abstract

The World Health Organization (WHO) proposed a global priority pathogen list (PPL) of multidrug-resistant (MDR) bacteria. Our current objective was to provide global expert ranking of the most serious MDR bacteria present at intensive care units (ICU) that have become a threat in clinical practice. A proposal addressing a 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 analysis (MCDA) was used to identify the priority tiers. After MCDA, 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. Carbapenem-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. We conclude that education, investigation, funding, and development of new antimicrobials for ICU organisms should focus on carbapenem-resistant Gram-negative organisms.

Publication Date
2019-02
Online Publication Date
2018-11-13
Acceptance Date
2018-11-07
Keywords
Antimicrobials, Colonization, Infection control, Intensive care, Multidrug-resistant bacteria, Prevention, Research, Sepsis, Anti-Bacterial Agents, Bacteria, Cross Infection, Decision Support Techniques, Drug Resistance, Multiple, Bacterial, Humans, Infection Control, Intensive Care Units, Practice Guidelines as Topic
Journal Title
Eur J Clin Microbiol Infect Dis
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.