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, Univerzitetni Klinični Center Ljubljana
B. Beovic, Univerzitetni Klinični Center Ljubljana
C. Pulcini, APEMAC Adaptation, Mesure et Evaluation en Santé
E. Durante-Mangoni, Università degli Studi della Campania Luigi Vanvitelli
J. Rodríguez-Baño, Hospital Universitario Virgen Macarena
K. S. Kaye, University of Michigan Medical School
G. L. Daikos, National and Kapodistrian University of Athens
L. Raka, National Institute of Public Health of Kosovo
M. Paul, Infectious Diseases Institute
L. Abbo, Jackson Memorial Hospital
P. Abgueguen, CHU Angers
B. Almirante, Hospital Universitari Vall d'Hebron
A. M. Azzini, Università degli Studi di Verona
F. Bani-Sadr, CHU de Reims
M. Bassetti, Policlinico Universitario, Udine
R. Ben-Ami, Tel Aviv Sourasky Medical Center
G. Béraud, Centre Hospitalier Universitaire de Poitiers
E. Botelho-Nevers, Centre Hospitalier Universitaire de Saint Etienne
G. Bou, Universidade da Coruña
D. Boutoille, CHU de Nantes
A. Cabié, Centre Hospitalier Universitaire de Fort de France
B. Cacopardo, Hospital Garibaldi
A. Cascio, Università degli Studi di Palermo
N. Cassir, AP-HM Assistance Publique - Hôpitaux de Marseille
F. Castelli, Spedali Civili Di Brescia
M. Cecala, ARNAS Civico
A. Charmillon, CHU de Nancy
C. Chirouze, Centre Hospitalier Universitaire de Besancon
J. M. Cisneros, Hospital Universitario Virgen del Rocío
J. D. Colmenero, Hospital Regional Universitario Carlos Haya
N. Coppola, Università degli Studi della Campania Luigi Vanvitelli
S. Corcione, Università degli Studi di Torino
D. Dalla Gasperina, Università degli Studi dell'Insubria


© 2018 European Society of Clinical Microbiology and Infectious Diseases 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.