CRIPS Department, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.
Centro Investigacion Biomedica en Red (CIBERES), Institut Salud Carlos III, Barcelona, Spain.
Eur J Clin Microbiol Infect Dis. 2020 Feb;39(2):385-392. doi: 10.1007/s10096-019-03736-3. Epub 2019 Nov 9.
A global cross-sectional survey was performed to gather data on the current treatment of infections caused by multidrug-resistant (MDR) bacteria among hematological patients admitted to ICUs worldwide. The survey was performed in April 2019 using an electronic platform (SurveyMonkey®) being distributed among 83 physicians and completed by 48 (57.8%) responders. ESBL Enterobacteriaceae, carbapenem-resistant K. pneumoniae and carbapenem-resistant P. aeruginosa were the main concerns. Previous MDR infection (34% of responders), MDR colonization (20%) and previous antibiotic exposure within the last 3 months (20.5%) were considered the most relevant risk factors of bloodstream infection (BSI) due to MDR bacteria. In 48.8% of the ICUs, there was no antimicrobial stewardship (AMS) team focused on hematological patients. Updates on local epidemiology of MDR pathogens were provided in 98% of the centers, using phone or verbal communications (56.1% and 53.7%, respectively). In presence of febrile neutropenia, initial therapy consisted of anti-Gram-negative plus anti-Gram-positive antibiotics for 41% of participants. Antibiotic de-escalation and/or discontinuation of therapy were considered as a promising strategy for the prevention of MDR development (32.4%). Factors associated with antibiotic de-escalation were clinical improvement (43.6%) and neutrophil count recovery (12.8%). Infectious Disease consultation and AMS interventions were not determining factors for de-escalation decisions (more than 50% of responders). Infection control and educational programs were valued as necessary measures for implementation by ICU practitioners. These findings should guide future efforts on collaborative team working, improving compliance with adequate treatment protocols, implementing antimicrobial stewardship programs in critically ill hematological patients, and educational activities.
一项全球性的横断面调查旨在收集全球 ICU 收治的血液病患者中多重耐药（MDR）细菌感染的当前治疗数据。该调查于 2019 年 4 月使用电子平台（SurveyMonkey®）进行，分发给 83 名医生，其中 48 名（57.8%）医生完成了调查。主要关注的是产 ESBL 肠杆菌科细菌、耐碳青霉烯类肺炎克雷伯菌和耐碳青霉烯类铜绿假单胞菌。既往 MDR 感染（34%的应答者）、MDR 定植（20%）和最近 3 个月内使用抗生素（20.5%）被认为是导致 MDR 细菌血流感染（BSI）的最相关危险因素。48.8%的 ICU 没有针对血液病患者的抗菌药物管理（AMS）团队。98%的中心通过电话或口头交流提供 MDR 病原体局部流行情况的更新，分别有 56.1%和 53.7%的中心使用这两种方式。在出现发热性中性粒细胞减少症的情况下，初始治疗包括针对革兰氏阴性菌和革兰氏阳性菌的抗生素，占 41%的参与者。抗生素降级和/或停止治疗被认为是预防 MDR 发展的一种有前途的策略（32.4%）。抗生素降级的相关因素是临床改善（43.6%）和中性粒细胞计数恢复（12.8%）。感染科会诊和 AMS 干预不是降级决策的决定因素（超过 50%的应答者）。感染控制和教育计划被认为是 ICU 从业者实施的必要措施。这些发现应指导未来在协作团队工作、提高对适当治疗方案的依从性、在危重病血液病患者中实施抗菌药物管理计划以及开展教育活动方面的努力。
