European intensive care physicians’ experience of infections due to antibiotic-resistant bacteria

Abstract

BackgroundAntimicrobial resistance (AMR) compromises the treatment of patients with serious infections in intensive care units (ICUs), and intensive care physicians are increasingly facing patients with bacterial infections with limited or no adequate therapeutic options. A survey was conducted to assess the intensive care physicians’ perception of the AMR situation in the European Union/European Economic Area (EU/EEA).MethodsBetween May and July 2017, physicians working in European ICUs were invited to complete an online questionnaire hosted by the European Society of Intensive Care Medicine. The survey included 20 questions on hospital and ICU characteristics, frequency of infections with multidrug-resistant (MDR) bacteria and relevance of AMR in the respondent’s ICU, management of antimicrobial treatment as well as the use of last-line antibiotics in the six months preceding the survey. For the analysis of regional differences, EU/EEA countries were grouped into the four sub-regions of Eastern, Northern, Southern and Western Europe.ResultsOverall, 1062 responses from four European sub-regions were analysed. Infections with MDR bacteria in their ICU were rated as a major problem by 257 (24.2%), moderate problem by 360 (33.9%) and minor problem by 391 (36.8%) respondents. Third-generation cephalosporin-resistant Enterobacteriaceae were the most frequently encountered MDR bacteria followed by, in order of decreasing frequency, meticillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa and vancomycin-resistant enterococci. Perception of the relevance of the AMR problem and the frequency of specific MDR bacteria varied by European sub-region. Bacteria resistant to all or almost all available antibiotics were encountered by 132 (12.4%) respondents. Many physicians reported not having access to specific last-line antibiotics.ConclusionsThe percentage of European ICU physicians perceiving AMR as a substantial problem in their ICU is high with variation by sub-region in line with epidemiological studies. The reports of bacteria resistant to almost all available antibiotics and the limited availability of last-line antibiotics in ICUs in the EU/EEA are of concern.

Synergistic antibacterial effects of colistin in combination with aminoglycoside, carbapenems, cephalosporins, fluoroquinolones, tetracyclines, fosfomycin, and piperacillin on multidrug resistant Klebsiella pneumoniae isolates

“…While the search for alternative antimicrobial agents that can effectively control the spread of multidrug resistance continues, various temporary measures are been employed for the treatment of infections caused by drug resistant bacterial isolates. Antibiotic combination therapy is a possible effective option which currently is attracting numerous research attention [ 34 – 36 ]. Combinations of antibiotics effectively inhibit microbial proliferation through a multi-target approach resulting in the microbial death.…”

Barriers to Adherence to Antimicrobial Stewardship Postprescription Review and Feedback For Broad-Spectrum Antimicrobial Agents: A Nested Case-Control Study

“…Previous studies have revealed that physicians caring for critically ill patients perceived AMR to be a substantial problem, and their perception of ASP seemed favorable [ 24 , 25 ], but fear of treatment failure or a worse clinical outcome in critically ill patients may discourage physicians from de-escalating or discontinuing antimicrobial therapy despite inappropriate use. Hence, ASP in critical care settings is particularly important.…”

Characterization and Genomic Study of Phage vB_EcoS-B2 Infecting Multidrug-Resistant Escherichia coli

“…Escherichia coli is a gram-negative bacterium, which can cause intestinal (diarrhea) or extraintestinal (urinary tract infection, septicaemia, pneumonia, and meningitis) diseases in humans and animals (Cabal et al, 2016 ). Current antibiotic treatments used to treat E. coli often result in a spread of multidrug resistance (MDR) of E. coli (Lepape and Monnet, 2009 ). For example, E. coli strains produce Extended-Spectrum Beta Lactamase and metallo-β-lactamas, enzymes which make E. coli become resistant to several antibiotic drugs (Peña et al, 2006 ; Birgy et al, 2011 ).…”