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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

L. Papst 1 B. Beović 1 C. Pulcini 2 E. Durante-Mangoni 3 J. Rodríguez-Baño 4 K.S. Kaye 5 G.L. Daikos 6 L. Raka 7 M. Paul 8 L. Abbo 9 P. Abgueguen 10 B. Almirante 11 A.M. Azzini 12 F. Bani-Sadr 13 M. Bassetti 14 R. Ben-Ami 15 G. Béraud 16 E. Botelho-Nevers 17 G. Bou 18 D. Boutoille 19 A. Cabié 20 B. Cacopardo 21 A. Cascio 22 N. Cassir 23 F. Castelli 24 M. Cecala 25 A. Charmillon 26 C. Chirouze 27 J.M. Cisneros 28 J.D. Colmenero 29 N. Coppola 30 S. Corcione 31 D. Dalla Gasperina 32 C. de la Calle Cabrera 33 P. Delobel 34 D. Di Caprio 35 E. Durante Mangoni 36 M. Dupon 37 N. Ettahar 38 M.E. Falagas 39 M. Falcone 40 M.C. Fariñas 41 Emmanuel Faure 42 E. Forestier 43 G. Fóti 44 J. Gallagher 45 G. Gattuso 46 V. Gendrin 47 I. Gentile 48 D.R. Giacobbe 49 C.A. Gogos 50 L. Grandiere Perez 51 Y. Hansmann 52 J.P. Horcajada 53 C. Iacobello 54 J.T. Jacob 55 J.A. Justo 56 S. Kernéis 57 A. Komnos 58 B. Kotnik Kevorkijan 59 D. Lebeaux 60 R. Le Berre 61 C. Lechiche 62 V. Le Moxing 63 F.X. Lescure 64 M. Libanore 65 M. Martinot 66 E. Merino de Lucas 67 V. Mondain 68 P. Mondello 69 M. Montejo 70 J. Mootien 71 P. Muñoz 72 R. Nir-Paz 73 A. Pan 74 J.R. Paño-Pardo 75 G. Patel 76 M.T. Pérez Rodríguez 77 L. Piroth 78 J. Pogue 79 B.A. Potoski 80 V. Pourcher 81 A. Pyrpasopoulou 82 G. Rahav 83 M. Rizzi 84 M. Salavert 85 M. Scheetz 86 M. Sims 87 G. Spahija 88 S. Stefani 89 A. Stefos 90 P.D. Tamma 91 P. Tattevin 92 A. Tedesco 93 J. Torre-Cisneros 94 P. Tripolitsioti 95 S. Tsiodras 96 G. Uomo 97 R. Verdon 98 P. Viale 99 V. Vitrat 100 M. Weinberger 101 Y. Wiener-Well 102
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.
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Submitted on : Thursday, November 21, 2019 - 9:40:57 AM
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L. Papst, B. Beović, C. Pulcini, E. Durante-Mangoni, J. Rodríguez-Baño, et al.. 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. Clinical Microbiology and Infection, Elsevier for the European Society of Clinical Microbiology and Infectious Diseases, 2018, 24 (10), pp.1070-1076. ⟨10.1016/j.cmi.2018.01.015⟩. ⟨hal-02373533⟩



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