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

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cam.issuedOnline2018-11-13
dc.contributor.authorRello, Jordi
dc.contributor.authorKalwaje Eshwara, Vandana
dc.contributor.authorLagunes, Leo
dc.contributor.authorAlves, Joana
dc.contributor.authorWunderink, Richard G
dc.contributor.authorConway-Morris, Andrew
dc.contributor.authorRojas, Jose Nicolas
dc.contributor.authorAlp, Emine
dc.contributor.authorZhang, Zhongheng
dc.contributor.orcidRello, Jordi [0000-0003-0676-6210]
dc.date.accessioned2018-12-13T00:31:24Z
dc.date.available2018-12-13T00:31:24Z
dc.date.issued2019-02
dc.description.abstractThe 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.
dc.description.sponsorshipThe 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.
dc.format.mediumPrint-Electronic
dc.identifier.doi10.17863/CAM.34108
dc.identifier.eissn1435-4373
dc.identifier.issn0934-9723
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/286801
dc.languageeng
dc.language.isoeng
dc.publisherSpringer Science and Business Media LLC
dc.publisher.urlhttp://dx.doi.org/10.1007/s10096-018-3428-y
dc.subjectAntimicrobials
dc.subjectColonization
dc.subjectInfection control
dc.subjectIntensive care
dc.subjectMultidrug-resistant bacteria
dc.subjectPrevention
dc.subjectResearch
dc.subjectSepsis
dc.subjectAnti-Bacterial Agents
dc.subjectBacteria
dc.subjectCross Infection
dc.subjectDecision Support Techniques
dc.subjectDrug Resistance, Multiple, Bacterial
dc.subjectHumans
dc.subjectInfection Control
dc.subjectIntensive Care Units
dc.subjectPractice Guidelines as Topic
dc.titleA global priority list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care: a prioritization exercise based on multi-criteria decision analysis.
dc.typeArticle
dcterms.dateAccepted2018-11-07
prism.endingPage323
prism.issueIdentifier2
prism.publicationDate2019
prism.publicationNameEur J Clin Microbiol Infect Dis
prism.startingPage319
prism.volume38
pubs.funder-project-idWellcome Trust (205214/Z/16/Z)
rioxxterms.licenseref.startdate2019-02
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionAM
rioxxterms.versionofrecord10.1007/s10096-018-3428-y

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