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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

2018; Elsevier BV; Volume: 24; Issue: 10 Linguagem: Inglês

10.1016/j.cmi.2018.01.015

1469-0691

Lea Papst, Bojana Beović, C. Pulcini, Emanuele Durante‐Mangoni, Jesús Rodríguez‐Baño, Keith S. Kaye, George L. Daikos, Lul Raka, Mical Paul, Lilian M. Abbo, P. Abgueguen, Benito Almirante, Anna Maria Azzini, Firouzé Bani‐Sadr, Matteo Bassetti, Ronen Ben‐Ami, B. Beović, Guillaume Béraud, Élisabeth Botelho-Nevers, Germán Bou, D. Boutoille, André Cabié, Bruno Cacopardo, Antonio Cascio, Nadim Cassir, Francesco Castelli, Mia Cecala, A. Charmillon, Catherine Chirouze, José Miguel Cisneros, Juan Colmenero, Nicola Coppola, Silvia Corcione, G.L. Daikos, Daniela Dalla Gasperina, Carlos Cabrera, Pierre Delobel, Debora Di Caprio, Emanuele Durante‐Mangoni, M. Dupon, N. Ettahar, M.E. Falagas, Marco Falcone, M.C. Fariñas, E. Faure, E. Forestier, G. Foti, J. Gallagher, Gianni Gattuso, V. Gendrin, Ivan Gentile, Daniele Roberto Giacobbe, Charalambos Gogos, L. Grandiere Perez, Y. Hansmann, Juan Pablo Horcajada, Carmelo Iacobello, Jesse T. Jacob, Julie Ann Justo, Solen Kernéis, A. Komnos, B. Kotnik Kevorkijan, David Lebeaux, R. Le Berre, C. Lechiche, V. Le Moxing, F.-X. Lescure, M. Libanore, M. Martinot, Esperanza Merino, V. Mondain, P. Mondello, Miguel Montejo, J. Mootien, Patricia Muñóz, Ran Nir‐Paz, Ailuan Pan, J.R. Paño‐Pardo, Gopi Patel, Mical Paul, Pérez Rodríguez, Lionel Piroth, Jason M. Pogue, Brian A. Potoski, Valérie Pourcher, A. Pyrpasopoulou, G. Rahav, Marco Rizzi, Jesús Rodríguez‐Baño, M. Salavert, Marc H. Scheetz, M Sims, Gazmend Spahija, S. Stefani, Aggelos Stefos, P.D. Tamma, P. Tattevin, Andrea Tedesco, José Miguel Cisneros, Paraskevi Tripolitsioti, Sotirios Tsiodras, Generoso Uomo, Renaud Verdon, Pierluigi Viale, Virginie Vitrat, Miriam Weinberger, Yonit Wiener‐Well,

Antibiotics Pharmacokinetics and Efficacy

ObjectivesTo explore contemporary antibiotic management of infections caused by carbapenem-resistant Gram-negative bacteria in hospitals.MethodsCross-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.ResultsBetween 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.ConclusionsCombination 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.