Perceived differences between intensivists and infectious diseases consultants facing antimicrobial resistance: a global cross-sectional survey.
Kalwaje Eshwara, Vandana
TOTEM Study Investigators,
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., Conway-Morris, A., Lagunes, L., Alves, J., Alp, E., Zhang, Z., et al. (2019). Perceived differences between intensivists and infectious diseases consultants facing antimicrobial resistance: a global cross-sectional survey.. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 38 (7), 1235-1240. https://doi.org/10.1007/s10096-019-03530-1
Objectives- To identify differences in perception on multi-drug resistant (MDR) organisms and their management at intensive care units (ICU). Methods- A cross-sectional survey was conducted. A proposal addressing a pathogens priority list (PPL) for ICU, arising from the TOTEM study, was compared with a sample of global experts in infections in critically ill patients. Results: 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%) was 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 Conclusion: 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.
TOTEM Study Investigators, Humans, Enterobacteriaceae, Communicable Diseases, Carbapenems, Anti-Bacterial Agents, Critical Care, Microbial Sensitivity Tests, Cohort Studies, Cross-Sectional Studies, Infection Control, Drug Resistance, Multiple, Bacterial, Physicians, Intensive Care Units, Global Health
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/s10096-019-03530-1
This record's URL: https://www.repository.cam.ac.uk/handle/1810/290309