Antibiotic treatment of infections caused by carbapenem-resistant Gram-negative bacilli

an international ESCMID cross-sectional survey among infectious diseases specialists practicing in large hospitals

ESGAP, ESGBIS, ESGIE and the CRGNB treatment survey study group

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1070-1076
Number of pages7
JournalClinical Microbiology and Infection
Volume24
Issue number10
DOIs
StatePublished - Oct 1 2018
Externally publishedYes

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Carbapenems
Bacillus
Communicable Diseases
Cross-Sectional Studies
Anti-Bacterial Agents
Infection
Polymyxins
Acinetobacter baumannii
Aminoglycosides
Enterobacteriaceae
Gram-Negative Bacteria
Pseudomonas aeruginosa
Therapeutics
Kosovo
Fosfomycin
Slovenia
Central Nervous System Infections
Greece
Israel
Tertiary Healthcare

Keywords

  • Acinetobacter baumannii
  • Carbapenem
  • Carbapenem-resistant Gram-negative bacilli
  • Combination therapy
  • Enterobacteriaceae
  • Polymyxin
  • Pseudomonas aeruginosa
  • Survey

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Antibiotic treatment of infections caused by carbapenem-resistant Gram-negative bacilli : an international ESCMID cross-sectional survey among infectious diseases specialists practicing in large hospitals. / ESGAP, ESGBIS, ESGIE and the CRGNB treatment survey study group.

In: Clinical Microbiology and Infection, Vol. 24, No. 10, 01.10.2018, p. 1070-1076.

Research output: Contribution to journalArticle

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abstract = "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.",
keywords = "Acinetobacter baumannii, Carbapenem, Carbapenem-resistant Gram-negative bacilli, Combination therapy, Enterobacteriaceae, Polymyxin, Pseudomonas aeruginosa, Survey",
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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 - Beović, 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, Lilian

AU - Abgueguen, P.

AU - Almirante, B.

AU - Azzini, A. M.

AU - Bani-Sadr, F.

AU - Bassetti, M.

AU - Ben-Ami, R.

AU - Beović, B.

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 - Daikos, G. L.

AU - Dalla Gasperina, D.

AU - De la Calle Cabrera, C.

AU - Delobel, P.

AU - Di Caprio, D.

AU - Durante Mangoni, E.

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.

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

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U2 - 10.1016/j.cmi.2018.01.015

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