Perceived differences between intensivists and infectious diseases consultants facing antimicrobial resistance: a global cross-sectional survey.
Jordi RelloVandana Kalwaje EshwaraAndrew Conway-MorrisLeonel LagunesJoana AlvesEmine AlpZhongheng ZhangMervyn Mernull nullPublished in: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (2019)
To identify differences in perception on multi-drug-resistant (MDR) organisms and their management at intensive care units (ICU). A cross-sectional survey was conducted. A proposal addressing a pathogen priority list (PPL) for ICU, arising from the TOTEM study, was compared with a sample of global experts in infections in critically ill patients. The survey was responded by 129 experts. Globally, ESBL Enterobacteriaceae, followed by carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae, were the main concerns. Some differences in opinion were identified between 63 (49%) ICU physicians (ICU/anesthesiology) and 43 (33%) infectious disease consultants (ID physicians/microbiologists). The pathogens most concerning in the ICU for intensivists were ESBL Enterobacteriaceae (38%) versus carbapenem-resistant A. baumannii (48.3%) for ID consultants, (p < 0.05). Increasing number of ID consultants over intensivists (26% vs 14%) reported difficulty in choosing initial therapy for carbapenem-resistant A. baumannii. For intensivists, the urgent measures to limit development of antibiotic resistance were headed by cohort measures (26.3%) versus increasing nurse/patient ratio (32.5%) for ID consultants, (p < 0.05). Regarding effectiveness to prevent MDR development and spread, education programs (42.4%) were the priority for intensivists versus external consultation (35.7%) for ID consultants. Finally, both groups agreed that carbapenem resistance was the most pressing concern (> 70%) regarding emerging resistance. Differences in priorities regarding organisms, infection control practices, and educational priorities were visualized between ID/clinical microbiologists and ICU/anesthesiologists. Multi-disciplinary collaboration is required to achieve best care for ICU patients with severe infections.
Keyphrases
- multidrug resistant
- klebsiella pneumoniae
- acinetobacter baumannii
- drug resistant
- gram negative
- intensive care unit
- infectious diseases
- mechanical ventilation
- antimicrobial resistance
- primary care
- healthcare
- escherichia coli
- pseudomonas aeruginosa
- palliative care
- randomized controlled trial
- depressive symptoms
- public health
- mental health
- physical activity
- quality improvement
- cystic fibrosis
- urinary tract infection
- cross sectional