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Published on: August 30, 2018
European intensive care physicians' experience of infections due to antibiotic-resistant bacteria
Alain Lepape1,2,3, Astrid Jean1,3, Jan De Waele2,4
11Clinical Research Unit, Critical care, Lyon-Sud University Hospital, Hospices Civils de Lyon, Lyon, France.
Background:
Antimicrobial 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).
Methods:
Between 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.
Results:
Overall, 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.
Conclusions:
The 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.
Insights
Antimicrobial resistance (AMR) is a significant concern for European intensive care unit (ICU) physicians, with many encountering multidrug-resistant bacteria and limited last-line antibiotic options. Regional variations in AMR perception and prevalence highlight the need for targeted strategies.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Public Health
Background:
- Antimicrobial resistance (AMR) poses a critical threat to treating severe infections in intensive care units (ICUs).
- Intensive care physicians face increasing challenges with bacterial infections resistant to available therapies.
- A survey assessed European intensive care physicians' perceptions of the AMR situation within the European Union/European Economic Area (EU/EEA).
Purpose of the Study:
- To evaluate intensive care physicians' perceptions of antimicrobial resistance (AMR) in European intensive care units (ICUs).
- To identify regional variations in AMR prevalence and physician awareness across the EU/EEA.
- To understand the challenges faced by physicians regarding multidrug-resistant (MDR) bacteria and last-line antibiotic availability.
Main Methods:
- An online questionnaire was distributed to European ICU physicians between May and July 2017.
- The survey collected data on ICU characteristics, frequency of multidrug-resistant (MDR) bacterial infections, and antimicrobial treatment practices.
- Responses were analyzed, with EU/EEA countries grouped into Eastern, Northern, Southern, and Western European sub-regions.
Main Results:
- Over 1000 physicians responded, with 24.2% rating AMR as a major problem in their ICU.
- Third-generation cephalosporin-resistant Enterobacteriaceae were the most common MDR bacteria, followed by MRSA and carbapenem-resistant strains.
- 12.4% of physicians encountered bacteria resistant to nearly all antibiotics, and many reported limited access to last-line treatments.
Conclusions:
- A high percentage of European ICU physicians perceive AMR as a substantial problem, with significant regional differences.
- The occurrence of extensively drug-resistant bacteria and restricted availability of last-line antibiotics in ICUs are significant concerns.
- Findings underscore the urgent need for enhanced AMR surveillance and management strategies in European ICUs.
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