TY - JOUR
T1 - Antibiotic treatment of infections caused by carbapenem-resistant Gram-negative bacilli
T2 - an international ESCMID cross-sectional survey among infectious diseases specialists practicing in large hospitals
AU - ESGAP, ESGBIS, ESGIE and the CRGNB treatment survey study group
AU - Papst, L.
AU - Beovic, B.
AU - Pulcini, C.
AU - Durante-Mangoni, E.
AU - Rodríguez-Baño, J.
AU - Kaye, K. S.
AU - Daikos, G. L.
AU - Raka, L.
AU - Paul, M.
AU - Abbo, L.
AU - Abgueguen, P.
AU - Almirante, B.
AU - Azzini, A. M.
AU - Bani-Sadr, F.
AU - Bassetti, M.
AU - Ben-Ami, R.
AU - Béraud, G.
AU - Botelho-Nevers, E.
AU - Bou, G.
AU - Boutoille, D.
AU - Cabié, A.
AU - Cacopardo, B.
AU - Cascio, A.
AU - Cassir, N.
AU - Castelli, F.
AU - Cecala, M.
AU - Charmillon, A.
AU - Chirouze, C.
AU - Cisneros, J. M.
AU - Colmenero, J. D.
AU - Coppola, N.
AU - Corcione, S.
AU - Dalla Gasperina, D.
AU - De la Calle Cabrera, C.
AU - Delobel, P.
AU - Di Caprio, D.
AU - Dupon, M.
AU - Ettahar, N.
AU - Falagas, M. E.
AU - Falcone, M.
AU - Fariñas, M. C.
AU - Faure, E.
AU - Forestier, E.
AU - Foti, G.
AU - Gallagher, J.
AU - Gattuso, G.
AU - Gendrin, V.
AU - Gentile, I.
AU - Giacobbe, D. R.
AU - Rahav, G.
N1 - Publisher Copyright:
© 2018 European Society of Clinical Microbiology and Infectious Diseases
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Objectives: To explore contemporary antibiotic management of infections caused by carbapenem-resistant Gram-negative bacteria in hospitals. Methods: Cross-sectional, internet-based questionnaire survey. We contacted representatives of all hospitals with more than 800 acute-care hospital beds in France, Greece, Israel, Italy, Kosovo, Slovenia, Spain and selected hospitals in the USA. We asked respondents to describe the most common actual practice at their hospital regarding management of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa through close-ended questions. Results: Between January and June 2017, 115 of 141 eligible hospitals participated (overall response rate 81.6%, country-specific rates 66.7%–100%). Most were tertiary-care (99/114, 86.8%), university-affiliated (110/115, 89.1%) hospitals and most representatives were infectious disease specialists (99/115, 86.1%). Combination therapy was prescribed in 114/115 (99.1%) hospitals at least occasionally. Respondents were more likely to consider combination therapy when treating bacteraemia, pneumonia and central nervous system infections and for Enterobacteriaceae, P. aeruginosa and A. baumannii similarly. Combination of a polymyxin with a carbapenem was used in most cases, whereas combinations of a polymyxin with tigecycline, an aminoglycoside, fosfomycin or rifampicin were also common. Monotherapy was used for treatment of complicated urinary tract infections, usually with an aminoglycoside or a polymyxin. The intended goal of combination therapy was to improve the effectiveness of the treatment and to prevent development of resistance. In general, respondents shared the misconception that combination therapy is supported by strong scientific evidence. Conclusions: Combination therapy was the preferred treatment strategy for infections caused by carbapenem-resistant Gram-negative bacteria among hospital representatives, even though high-quality evidence for carbapenem-based combination therapy is lacking.
AB - Objectives: To explore contemporary antibiotic management of infections caused by carbapenem-resistant Gram-negative bacteria in hospitals. Methods: Cross-sectional, internet-based questionnaire survey. We contacted representatives of all hospitals with more than 800 acute-care hospital beds in France, Greece, Israel, Italy, Kosovo, Slovenia, Spain and selected hospitals in the USA. We asked respondents to describe the most common actual practice at their hospital regarding management of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa through close-ended questions. Results: Between January and June 2017, 115 of 141 eligible hospitals participated (overall response rate 81.6%, country-specific rates 66.7%–100%). Most were tertiary-care (99/114, 86.8%), university-affiliated (110/115, 89.1%) hospitals and most representatives were infectious disease specialists (99/115, 86.1%). Combination therapy was prescribed in 114/115 (99.1%) hospitals at least occasionally. Respondents were more likely to consider combination therapy when treating bacteraemia, pneumonia and central nervous system infections and for Enterobacteriaceae, P. aeruginosa and A. baumannii similarly. Combination of a polymyxin with a carbapenem was used in most cases, whereas combinations of a polymyxin with tigecycline, an aminoglycoside, fosfomycin or rifampicin were also common. Monotherapy was used for treatment of complicated urinary tract infections, usually with an aminoglycoside or a polymyxin. The intended goal of combination therapy was to improve the effectiveness of the treatment and to prevent development of resistance. In general, respondents shared the misconception that combination therapy is supported by strong scientific evidence. Conclusions: Combination therapy was the preferred treatment strategy for infections caused by carbapenem-resistant Gram-negative bacteria among hospital representatives, even though high-quality evidence for carbapenem-based combination therapy is lacking.
KW - Acinetobacter baumannii
KW - Carbapenem
KW - Carbapenem-resistant Gram-negative bacilli
KW - Combination therapy
KW - Enterobacteriaceae
KW - Polymyxin
KW - Pseudomonas aeruginosa
KW - Survey
UR - http://www.scopus.com/inward/record.url?scp=85043360070&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2018.01.015
DO - 10.1016/j.cmi.2018.01.015
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C2 - 29410094
AN - SCOPUS:85043360070
SN - 1198-743X
VL - 24
SP - 1070
EP - 1076
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 10
ER -