Attitudes of physicians from 10 European countries on adherence and how treatment modalities in ABSSSI affect adherence: results from a Delphi survey

Abstract

To explore the attitudes of European physicians on adherence and how treatment modalities impact adherence in complicated forms of soft skin and skin structure infections, now referred as acute bacterial skin and skin structures infections (ABSSSI). After literature review, a questionnaire was prepared. Topics focused on (1) the importance of adherence, (2) the importance of administration regimen on adherence, (3) the importance of drug selection on adherence, (4) the importance of complexity on choice of drug for treatment, (5) the role of adherence in drug resistance, and (6) the role of adherence in administration of long-acting antibiotics (ABs). The questionnaire was administered to 323 European infectious diseases specialists, of whom 74% responded. A modified Delphi method was used to obtain the highest consensus. Results varied by countries. We found a high degree of agreement of the importance of adherence in ABSSSI treatment. Experts agreed that complexity of patient’s conditions, drug selection, drug resistance, the type of regimen, and the number of infusions impact adherence. Two items linking oral switching and adherence did not reach consensus. Adherence for ABSSSI therapies appears a crucial factor for therapeutic management and reduces the risk of AB resistance. Among new treatment opportunities, long-acting agents, with their characteristics, may represent an interesting options.Electronic supplementary materialThe online version of this article (10.1007/s10096-018-3264-0) contains supplementary material, which is available to authorized users.

Management of superficial and deep surgical site infection: an international multidisciplinary consensus

“…In further considerations on the route of administration, the panel expressed a consensus for using a single infusion covering the entire antimicrobial course (4.3.1) to improve adherence by avoiding the need for multiple (daily) dosing (4.3.3). This is consistent with the findings of a Delphi process conducted with 238 clinicians (61% infectious disease specialists) in 10 European countries, which showed a strong consensus on the importance of adherence and the advantages of administering long-acting drugs for acute bacterial skin and skin structures infections [ 38 ]. Long-acting lipoglycopeptide antimicrobials such as dalbavancin and oritavancin provide intrinsic treatment adherence due to their long half-lives [ 39 ].…”

“…The validated questionnaire was administered to the Delphi group of international experts in the field of SSI only once. The objectivity of the results may have increased with an additional round; however, this strategy has been used successfully in other Delphi procedures with heterogeneous panels [ 9 , 38 , 40 ]. Secondly, the Delphi population was identified through purposive sampling based on the contributions of potential participants to the international literature and their professional reputations, with the aim of obtaining input from established experts in different specialties working in several European countries; this should be considered when interpreting the responses.…”

Antimicrobial Management of Complicated Skin and Soft Tissue Infections in an Era of Emerging Multi-Drug Resistance: Perspectives from 5 Gulf Countries

“…A switch to oral therapy is possible if the clinical criteria for oral antibiotic treatment are fulfilled [70]. Nevertheless, adherence to oral antibiotic treatment in cSSTIs is often jeopardized by reduced compliance rates [71]. Empirical treatment regimens frequently used in the treatment of MRSA cSSTI under different bacterial etiology and clinical conditions, their limitations, available alternatives, and common toxicities associated with the antibiotic of choice are shown in Table 5 [2,72-80].…”

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“…Consensus for each statement was defined a priori as at least 66% agreement of respondents [20]. A statement achieved consensus when ≥66% of respondents gave a score of 1 or 2 (negative consensus) or ≥66% gave a score of 3, 4 or 5 (positive consensus).…”