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3. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline

Author

Ullmann, A.J., Aguado, J.M., Arikan-Akdagli, S., Denning, D.W., Groll, A.H., Lagrou, K., Lass-Flörl, C., Lewis, R.E., Munoz, P., Verweij, P.E., Warris, A., Ader, F., Akova, M., Arendrup, M.C., Barnes, R.A., Beigelman-Aubry, C., Blot, S., Bouza, E., Brüggemann, R.J.M., Buchheidt, D., Cadranel, J., Castagnola, E., Chakrabarti, A., Cuenca-Estrella, M., Dimopoulos, G., Fortun, J., Gangneux, J.-P., Garbino, J., Heinz, W.J., Herbrecht, R., Heussel, C.P., Kibbler, C.C., Klimko, N., Kullberg, B.J., Lange, C., Lehrnbecher, T., Löffler, J., Lortholary, O., Maertens, J., Marchetti, O., Meis, J.F., Pagano, L., Ribaud, P., Richardson, M., Roilides, E., Ruhnke, M., Sanguinetti, M., Sheppard, D.C., Sinkó, J., Skiada, A., Vehreschild, M.J.G.T., Viscoli, C., and Cornely, O.A.

Published
2018
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4. Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study

Author

Hoenigl, M., Salmanton-García, J., Egger, M., Gangneux, J.P., Bicanic, T., Arikan-Akdagli, S., Alastruey-Izquierdo, A., Klimko, N., Barac, A., Özenci, V., Meijer, E.F.J., Khanna, N., Bassetti, M., Rautemaa-Richardson, R., Lagrou, K., Adam, K.M., Akalin, E.H., Akova, M., Arsenijevic, V. Arsic, Aujayeb, A., Blennow, O., Bretagne, S., Danion, F., Denis, B., Jonge, N.A. de, Desoubeaux, G., Drgona, L., Erben, N., Gori, A., Rodríguez, J. García, Garcia-Vidal, C., Giacobbe, D.R., Goodman, A.L., Hamal, P., Hammarström, H., Toscano, C., Lanternier, F., Lass-Flörl, C., Lockhart, D.E.A., Longval, T., Loughlin, L., Matos, T., Mikulska, M., Narayanan, M., Martín-Pérez, S., Prattes, J., Rogers, B., Rahimli, L., Ruiz, M., Roilides, E., Samarkos, M., Scharmann, U., Sili, U., Sipahi, O.R., Sivakova, A., Steinmann, J., Trauth, J., Turhan, O., Praet, J. Van, Vena, A., White, P.L., Willinger, B., Tortorano, A.M., Arendrup, M.C., Koehler, P., Cornely, O.A., Hoenigl, M., Salmanton-García, J., Egger, M., Gangneux, J.P., Bicanic, T., Arikan-Akdagli, S., Alastruey-Izquierdo, A., Klimko, N., Barac, A., Özenci, V., Meijer, E.F.J., Khanna, N., Bassetti, M., Rautemaa-Richardson, R., Lagrou, K., Adam, K.M., Akalin, E.H., Akova, M., Arsenijevic, V. Arsic, Aujayeb, A., Blennow, O., Bretagne, S., Danion, F., Denis, B., Jonge, N.A. de, Desoubeaux, G., Drgona, L., Erben, N., Gori, A., Rodríguez, J. García, Garcia-Vidal, C., Giacobbe, D.R., Goodman, A.L., Hamal, P., Hammarström, H., Toscano, C., Lanternier, F., Lass-Flörl, C., Lockhart, D.E.A., Longval, T., Loughlin, L., Matos, T., Mikulska, M., Narayanan, M., Martín-Pérez, S., Prattes, J., Rogers, B., Rahimli, L., Ruiz, M., Roilides, E., Samarkos, M., Scharmann, U., Sili, U., Sipahi, O.R., Sivakova, A., Steinmann, J., Trauth, J., Turhan, O., Praet, J. Van, Vena, A., White, P.L., Willinger, B., Tortorano, A.M., Arendrup, M.C., Koehler, P., and Cornely, O.A.

Abstract

Item does not contain fulltext, BACKGROUND: The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes. METHODS: In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope CandiReg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines. FINDINGS: 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1·08 [95% CI 1·04-1·11; p<0·0001] in patients with a central venous catheter and 1·09 [1·05-1·13; p<0·0001] in those without one, per one score point decrease). Median duration of hospital stay was 15 days (IQR 4-30) after diagnosis of candidaemia and was extended specifically for completion of parenteral therapy in 100 (16%) of 621 patients. Initial echinocandin treatment was associated with lower overall mortality and longer duration of hospital stay among survivors than treatment

Published
2023

6. Performance of existing definitions and tests for the diagnosis of invasive aspergillosis in critically ill, non-neutropenic, adult patients: An update including COVID-19 data

Author

Bassetti, Matteo, primary, Zuccaro, Valentina, additional, Asperges, Erika, additional, Scudeller, Luigia, additional, Giacobbe, Daniele Roberto, additional, Akova, M., additional, Alastruey-Izquierdo, A., additional, Arikan-Akdagli, S., additional, Azoulay, E., additional, Blot, S., additional, Cortegiani, A., additional, Cornely, O.A., additional, Grecchi, C., additional, Lass-Flörl, C., additional, Koehler, P., additional, Cuenca-Estrella, M., additional, de Lange, D.W., additional, De Rosa, F.G., additional, De Waele, J.J., additional, Dimopoulos, G., additional, Garnacho-Montero, J., additional, Hoenigl, M., additional, Kanj, S.S., additional, Lamoth, F., additional, Maertens, J., additional, Martin-Loeches, I., additional, Muñoz, P., additional, Kullberg, B.J., additional, Agvald-Ohman, C., additional, Poulakou, G., additional, Rebuffi, C., additional, Rello, J., additional, Sanguinetti, M., additional, Taccone, F.S., additional, Timsit, J-F., additional, Torres, A., additional, Vazquez, J.A., additional, Wauters, J., additional, Calandra, T., additional, Tejada, S., additional, Karaiskos, I., additional, Peghin, M., additional, Vena, A., additional, Mortensen, K.L., additional, Lebihan, C., additional, and Mercier, T., additional

Published
2022
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10. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi

Author

Chowdhary, A., Meis, J.F., Guarro, J., de Hoog, G.S., Kathuria, S., Arendrup, M.C., Arikan-Akdagli, S., Akova, M., Boekhout, T., Caira, M., Guinea, J., Chakrabarti, A., Dannaoui, E., van Diepeningen, A., Freiberger, T., Groll, A.H., Hope, W.W., Johnson, E., Lackner, M., Lagrou, K., Lanternier, F., Lass-Flörl, C., Lortholary, O., Meletiadis, J., Muñoz, P., Pagano, L., Petrikkos, G., Richardson, M.D., Roilides, E., Skiada, A., Tortorano, A.M., Ullmann, A.J., Verweij, P.E., Cornely, O.A., and Cuenca-Estrella, M.

Published
2014
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11. ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others

Author

Tortorano, A.M., Richardson, M., Roilides, E., van Diepeningen, A., Caira, M., Munoz, P., Johnson, E., Meletiadis, J., Pana, Z.-D., Lackner, M., Verweij, P., Freiberger, T., Cornely, O.A., Arikan-Akdagli, S., Dannaoui, E., Groll, A.H., Lagrou, K., Chakrabarti, A., Lanternier, F., Pagano, L., Skiada, A., Akova, M., Arendrup, M.C., Boekhout, T., Chowdhary, A., Cuenca-Estrella, M., Guinea, J., Guarro, J., de Hoog, S., Hope, W., Kathuria, S., Lortholary, O., Meis, J.F., Ullmann, A.J., Petrikkos, G., and Lass-Flörl, C.

Published
2014
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12. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013

Author

Cornely, O.A., Arikan-Akdagli, S., Dannaoui, E., Groll, A.H., Lagrou, K., Chakrabarti, A., Lanternier, F., Pagano, L., Skiada, A., Akova, M., Arendrup, M.C., Boekhout, T., Chowdhary, A., Cuenca-Estrella, M., Freiberger, T., Guinea, J., Guarro, J., de Hoog, S., Hope, W., Johnson, E., Kathuria, S., Lackner, M., Lass-Flörl, C., Lortholary, O., Meis, J.F., Meletiadis, J., Muñoz, P., Richardson, M., Roilides, E., Tortorano, A.M., Ullmann, A.J., van Diepeningen, A., Verweij, P., and Petrikkos, G.

Published
2014
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13. Performance of existing definitions and tests for the diagnosis of invasive aspergillosis in critically ill, non-neutropenic, adult patients: An update including COVID-19 data

Author

Bassetti, M., Zuccaro, V., Asperges, E., Scudeller, L., Giacobbe, D. R., Akova, M., Alastruey-Izquierdo, A., Arikan-Akdagli, S., Azoulay, E., Blot, S., Cortegiani, A., Cornely, O. A., Grecchi, C., Lass-Florl, C., Koehler, P., Cuenca-Estrella, M., de Lange, D. W., De Rosa, F. G., De Waele, J. J., Dimopoulos, G., Garnacho-Montero, J., Hoenigl, M., Kanj, S. S., Lamoth, F., Maertens, J., Martin-Loeches, I., Munoz, P., Kullberg, B. J., Agvald-Ohman, C., Poulakou, G., Rebuffi, C., Rello, J., Sanguinetti, Maurizio, Taccone, F. S., Timsit, J. -F., Torres, A., Vazquez, J. A., Wauters, J., Calandra, T., Tejada, S., Karaiskos, I., Peghin, M., Vena, A., Mortensen, K. L., Lebihan, C., Mercier, T., Sanguinetti M. (ORCID:0000-0002-9780-7059), Bassetti, M., Zuccaro, V., Asperges, E., Scudeller, L., Giacobbe, D. R., Akova, M., Alastruey-Izquierdo, A., Arikan-Akdagli, S., Azoulay, E., Blot, S., Cortegiani, A., Cornely, O. A., Grecchi, C., Lass-Florl, C., Koehler, P., Cuenca-Estrella, M., de Lange, D. W., De Rosa, F. G., De Waele, J. J., Dimopoulos, G., Garnacho-Montero, J., Hoenigl, M., Kanj, S. S., Lamoth, F., Maertens, J., Martin-Loeches, I., Munoz, P., Kullberg, B. J., Agvald-Ohman, C., Poulakou, G., Rebuffi, C., Rello, J., Sanguinetti, Maurizio, Taccone, F. S., Timsit, J. -F., Torres, A., Vazquez, J. A., Wauters, J., Calandra, T., Tejada, S., Karaiskos, I., Peghin, M., Vena, A., Mortensen, K. L., Lebihan, C., Mercier, T., and Sanguinetti M. (ORCID:0000-0002-9780-7059)

Abstract

Not available

Published
2022

14. ESCMID guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients

Author

Cornely, O.A., Bassetti, M., Calandra, T., Garbino, J., Kullberg, B.J., Lortholary, O., Meersseman, W., Akova, M., Arendrup, M.C., Arikan-Akdagli, S., Bille, J., Castagnola, E., Cuenca-Estrella, M., Donnelly, J.P., Groll, A.H., Herbrecht, R., Hope, W.W., Jensen, H.E., Lass-Florl, C., Petrikkos, G., Richardson, M.D., Roilides, E., Verweij, P.E., Viscoli, C., and Ullmann, A.J.

Published
2012
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15. ESCMID guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT)

Author

Ullmann, A.J., Akova, M., Herbrecht, R., Viscoli, C., Arendrup, M.C., Arikan-Akdagli, S., Bassetti, M., Bille, J., Calandra, T., Castagnola, E., Cornely, O.A., Donnelly, J.P., Garbino, J., Groll, A.H., Hope, W.W., Jensen, H.E., Kullberg, B.J., Lass-Flörl, C., Lortholary, O., Meersseman, W., Petrikkos, G., Richardson, M.D., Roilides, E., Verweij, P.E., and Cuenca-Estrella, M.

Published
2012
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16. ESCMID guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp.

Author

Hope, W.W., Castagnola, E., Groll, A.H., Roilides, E., Akova, M., Arendrup, M.C., Arikan-Akdagli, S., Bassetti, M., Bille, J., Cornely, O.A., Cuenca-Estrella, M., Donnelly, J.P., Garbino, J., Herbrecht, R., Jensen, H.E., Kullberg, B.J., Lass-Flörl, C., Lortholary, O., Meersseman, W., Petrikkos, G., Richardson, M.D., Verweij, P.E., Viscoli, C., and Ullmann, A.J.

Published
2012
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17. ESCMID guideline for the diagnosis and management of Candida diseases 2012: patients with HIV infection or AIDS

Author

Lortholary, O., Petrikkos, G., Akova, M., Arendrup, M.C., Arikan-Akdagli, S., Bassetti, M., Bille, J., Calandra, T., Castagnola, E., Cornely, O.A., Cuenca-Estrella, M., Donnelly, J.P., Garbino, J., Groll, A.H., Herbrecht, R., Hope, W.W., Jensen, H.E., Kullberg, B.J., Lass-Flörl, C., Meersseman, W., Richardson, M.D., Roilides, E., Verweij, P.E., Viscoli, C., and Ullmann, A.J.

Published
2012
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18. ESCMID guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures

Author

Cuenca-Estrella, M., Verweij, P. E, Arendrup, M. C, Arikan-Akdagli, S., Bille, J., Donnelly, J. P, Jensen, H. E, Lass-Flörl, C., Richardson, M. D, Akova, M., Bassetti, M., Calandra, T., Castagnola, E., Cornely, O. A, Garbino, J., Groll, A. H, Herbrecht, R., Hope, W. W, Kullberg, B. J, Lortholary, O., Meersseman, W., Petrikkos, G., Roilides, E., Viscoli, C., and Ullmann, A. J

Published
2012
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19. ESCMID guideline for the diagnosis and management of Candida diseases 2012: developing European guidelines in clinical microbiology and infectious diseases

Author

Ullmann, A.J., Cornely, O.A., DonneNy, J.P., Akova, M., Arendrup, M.C., Arikan-Akdagli, S., Bassetti, M., Bille, J., Calandra, T., Castagnola, E., Garbino, J., Groll, A.H., Herbrecht, R., Hope, W.W., Jensen, H.E., Kullberg, B.J., Lass-Flörl, C., Lortholary, O., Meersseman, W., Petrikkos, G., Richardson, M.D., Roilides, E., Verweij, P.E., Viscoli, C., and Cuenca-Estrella, M.

Published
2012
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25. Risk factors for gram-negative infection of cardiovascular implantable electronic devices: retrospective multicenter study - CarDINe study

Author

Pascale, R, primary, Abdullah, TA, additional, Fabbricatore, D, additional, De Potter, T, additional, Ripa, M, additional, Durante-Mangoni, E, additional, Leventopulos, G, additional, Domenichini, G, additional, Iacopino, S, additional, Akova, M, additional, Diemberger, I, additional, Viale, P, additional, and Giannella, M, additional

Published
2022
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26. European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli (endorsed by European society of intensive care medicine)

Author

Paul, M. Carrara, E. Retamar, P. Tängdén, T. Bitterman, R. Bonomo, R.A. de Waele, J. Daikos, G.L. Akova, M. Harbarth, S. Pulcini, C. Garnacho-Montero, J. Seme, K. Tumbarello, M. Lindemann, P.C. Gandra, S. Yu, Y. Bassetti, M. Mouton, J.W. Tacconelli, E. Rodríguez-Baño, J.

Abstract

Scope: These ESCMID guidelines address the targeted antibiotic treatment of third-generation cephalosporin-resistant Enterobacterales (3GCephRE) and carbapenem-resistant Gram-negative bacteria, focusing on the effectiveness of individual antibiotics and on combination versus monotherapy. Methods: An expert panel was convened by ESCMID. A systematic review was performed including randomized controlled trials and observational studies, examining different antibiotic treatment regimens for the targeted treatment of infections caused by the 3GCephRE, carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii. Treatments were classified as head-to-head comparisons between individual antibiotics and between monotherapy and combination therapy regimens, including defined monotherapy and combination regimens only. The primary outcome was all-cause mortality, preferably at 30 days and secondary outcomes included clinical failure, microbiological failure, development of resistance, relapse/recurrence, adverse events and length of hospital stay. The last search of all databases was conducted in December 2019, followed by a focused search for relevant studies up until ECCMID 2021. Data were summarized narratively. The certainty of the evidence for each comparison between antibiotics and between monotherapy and combination therapy regimens was classified by the GRADE recommendations. The strength of the recommendations for or against treatments was classified as strong or conditional (weak). Recommendations: The guideline panel reviewed the evidence per pathogen, preferably per site of infection, critically appraising the existing studies. Many of the comparisons were addressed in small observational studies at high risk of bias only. Notably, there was very little evidence on the effects of the new, recently approved, β-lactam/β-lactamase inhibitors on infections caused by carbapenem-resistant Gram-negative bacteria. Most recommendations are based on very-low- and low-certainty evidence. A high value was placed on antibiotic stewardship considerations in all recommendations, searching for carbapenem-sparing options for 3GCephRE and limiting the recommendations of the new antibiotics for severe infections, as defined by the sepsis-3 criteria. Research needs are addressed. © 2021 European Society of Clinical Microbiology and Infectious Diseases

Published
2022

28. European expert opinion on the management of invasive candidiasis in adults

Author

Kullberg, B.J., Verweij, P.E., Akova, M., Arendrup, M.C., Bille, J., Calandra, T., Cuenca-Estrella, M., Herbrecht, R., Jacobs, F., Kalin, M., Kibbler, C.C., Lortholary, O., Martino, P., Meis, J.F., Muñoz, P., Odds, F.C., De Pauw, B.E., Rex, J.H., Roilides, E., Rogers, T.R., Ruhnke, M., Ullmann, A.J., Uzun, Ö., Vandewoude, K., Vincent, J.-L., and Donnelly, J.P.

Published
2011
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29. Risk factors for target non-attainment during empirical treatment with [beta]-lactam antibiotics in critically ill patients

Author

De Waele, Jan J., Lipman, J., Akova, M., Bassetti, M., Dimopoulos, G., Kaukonen, M., and Koulenti, D.

Subjects
Beta lactamases, Beta lactam antibiotics, Antibacterial agents, Health care industry
Abstract

Purpose Risk factors for [beta]-lactam antibiotic underdosing in critically ill patients have not been described in large-scale studies. The objective of this study was to describe pharmacokinetic/pharmacodynamic (PK/PD) target non-attainment envisioning empirical dosing in critically ill patients and considering a worst-case scenario as well as to identify patient characteristics that are associated with target non-attainment. Methods This analysis uses data from the DALI study, a prospective, multi-centre pharmacokinetic point-prevalence study. For this analysis, we assumed that these were the concentrations that would be reached during empirical dosing, and calculated target attainment using a hypothetical target minimum inhibitory concentration (MIC), namely the susceptibility breakpoint of the least susceptible organism for which that antibiotic is commonly used. PK/PD targets were free drug concentration maintained above the MIC of the suspected pathogen for at least 50 % and 100 % of the dosing interval respectively (50 % and 100 % fT.sub.>MIC). Multivariable analysis was performed to identify factors associated with inadequate antibiotic exposure. Results A total of 343 critically ill patients receiving eight different [beta]-lactam antibiotics were included. The median (interquartile range) age was 60 (47-73) years, APACHE II score was 18 (13-24). In the hypothetical situation of empirical dosing, antibiotic concentrations remained below the MIC during 50 % and 100 % of the dosing interval in 66 (19.2 %) and 142 (41.4 %) patients respectively. The use of intermittent infusion was significantly associated with increased risk of non-attainment for both targets; creatinine clearance was independently associated with not reaching the 100 % fT.sub.>MIC target. Conclusions This study found that-in empirical dosing and considering a worst-case scenario-19 % and 41 % of the patients would not achieve antibiotic concentrations above the MIC during 50 % and 100 % of the dosing interval. The use of intermittent infusion (compared to extended and continuous infusion) was the main determinant of non-attainment for both targets; increasing creatinine clearance was also associated with not attaining concentrations above the MIC for the whole dosing interval. In the light of this study from 68 ICUs across ten countries, we believe current empiric dosing recommendations for ICU patients are inadequate to effectively cover a broad range of susceptible organisms and need to be reconsidered., Author(s): Jan J. De Waele [sup.1], J. Lipman [sup.2] [sup.3], M. Akova [sup.4], M. Bassetti [sup.5], G. Dimopoulos [sup.6], M. Kaukonen [sup.7] [sup.8], D. Koulenti [sup.2], C. Martin [sup.9], P. [...]

Published
2014
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30. The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study

Author

Erdem, H., Stahl, J. P., Inan, A., Kilic, S., Akova, M., Rioux, C., Pierre, I., Canestri, A., Haustraete, E., Engin, D. O., Parlak, E., Argemi, X., Bruley, D., Alp, E., Greffe, S., Hosoglu, S., Patrat-Delon, S., Heper, Y., Tasbakan, M., Corbin, V., Hopoglu, M., Balkan, I. I., Mutlu, B., Demonchy, E., Yilmaz, H., Fourcade, C., Toko-Tchuindzie, L., Kaya, S., Engin, A., Yalci, A., Bernigaud, C., Vahaboglu, H., Curlier, E., Akduman, D., Barrelet, A., Oncu, S., Korten, V., Usluer, G., Turgut, H., Sener, A., Evirgen, O., Elaldi, N., and Gorenek, L.

Published
2014
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32. Organization and training at national level of antimicrobial stewardship and infection control activities in Europe: an ESCMID cross-sectional survey

Author

Maraolo, AE, Ong, DSY, Cimen, C, Howard, P, Kofteridis, DP, Schouten, J, Mutters, NT, Pulcini, C, Harxhi, A, Presterl, E, Zeller, I, Wechsler- Fördös, A, Gurbanov, A, Vandendriessche, S, Jansens, H, Kostyanev, T, Vatcheva-Dobrevska, R, Sabolić, M, Civljak, R, Vlahović-Palčevski, Vera, Trojanek, M, Yiannitsarou, M, Tsioutis, C, Obrink-Hansen, K, Olesen, B, Jaaniso, K, Ala-Houhala, M, Jarlier, V, Bleibtreu, A, Zapf, TC, Kern, WV, Mattner, F, Zaragkoulias, K, Tsakris, A, Hajdú, E, Prinz, G, Gergely, SB, Doherty, A, Schaffer, K, Fleming, A, Hussein, K, Carrara, E, Pagani, L, Giacobbe, DR, Ponosheci-Bicaku, A, Raka, L, Krasniqi, S, Grāmatniece, A, Dumpis, U, Valinteliene, R, Kacergius, T, Knepper, V, Zarb, P, Wagenvoort, G, Voss, A, Akselsen, PE, Berild, D, Kubiak, J, Deptuła, A, Wanke-Rytt, M, de Sousa Fernandes, FS, Rocha-Pereira, N, Palos, C, Kostova, NM, Iacob, DG, Sandulescu, O, Filip, R, Barac, A, Krčméry, V, Plesko, M, Zupanc, TL, Beović, B, Pardo, JRP, Horcajada, JP, Baena, ZP, Tängdén, T, Johansson, A, Rönnberg, C, Huttner, B, Zingg, W, Akova, M, Ergönül, Ö, Holmes, A, Cevik, M, Salmanov, A, National Institute for Health Research, ESGAP-EUCIC-TAE Working Group on AMS/IPC mapping in Europe, University of St Andrews. School of Medicine, University of Naples Federico II, Sint Franciscus Gasthuis, University Medical Center [Utrecht], Ardahan Public Hospital, Leeds Teaching Hospitals NHS Trust, University Hospital of Heraklion, Radboud University Medical Center [Nijmegen], University of Freiburg [Freiburg], Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), and Université de Lorraine (UL)

Subjects
0301 basic medicine, Cross-sectional study, Antimicrobial stewardship, BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti. Klinička farmakologija s toksikologijom, BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences. Medical Microbiology, 0302 clinical medicine, Hospital Administration, Surveys and Questionnaires, Medical Laboratory Personnel, Infection control, QR180 Immunology, 030212 general & internal medicine, 11 Medical and Health Sciences, Infection prevention and control, Clinical microbiology, Infectious diseases, Questionnaire, General Medicine, 3. Good health, Europe, Infectious Diseases, Infection -- Prevention, QR180, Respondent, Anti-infective agents, Original Article, Education, Medical, Continuing, Infection -- Control, Microbiology (medical), medicine.medical_specialty, 030106 microbiology, NDAS, Specialty, Staffing, Microbiology, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, SDG 3 - Good Health and Well-being, parasitic diseases, medicine, Humans, National level, cardiovascular diseases, Infection Control, Infection Control Practitioners, business.industry, Medical microbiology -- Case studies, 06 Biological Sciences, BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences. Clinical Pharmacology and Toxicology, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], Cross-Sectional Studies, Family medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti. Medicinska mikrobiologija
Abstract

Antimicrobial stewardship (AMS) and Infection prevention and control (IPC) are two key complementary strategies that combat development and spread of antimicrobial resistance. The ESGAP (ESCMID Study Group for AMS), EUCIC (European Committee on Infection Control) and TAE (Trainee Association of ESCMID) investigated how AMS and IPC activities and training are organized, if present, at national level in Europe. From February 2018 to May 2018, an internet-based cross-sectional survey was conducted through a 36-item questionnaire, involving up to three selected respondents per country, from 38 European countries in total (including Israel), belonging to the ESGAP/EUCIC/TAE networks. All 38 countries participated with at least one respondent, and a total of 81 respondents. Education and involvement in AMS programmes were mandatory during the postgraduate training of clinical microbiology and infectious diseases specialists in up to one-third of countries. IPC was acknowledged as a specialty in 32% of countries. Only 32% of countries had both guidance and national requirements regarding AMS programmes, in contrast to 61% for IPC. Formal national staffing standards for AMS and IPC hospital-based activities were present in 24% and 63% of countries, respectively. The backgrounds of professionals responsible for AMS and IPC programmes varied tremendously between countries. The organization and training of AMS and IPC in Europe are heterogeneous and national requirements for activities are frequently lacking., peer-reviewed

Published
2019

33. Impact of the Inclusion of an Aminoglycoside to the Initial Empirical Antibiotic Therapy for Gram-Negative Bloodstream Infections in Hematological Neutropenic Patients: a Propensity-Matched Cohort Study (AMINOLACTAM Study)

Author

Albasanz-Puig, A., primary, Gudiol, C., additional, Puerta-Alcalde, P., additional, Ayaz, C. M., additional, Machado, M., additional, Herrera, F., additional, Martín-Dávila, P., additional, Laporte-Amargós, J., additional, Cardozo, C., additional, Akova, M., additional, Álvarez-Uría, A., additional, Torres, D., additional, Fortún, J., additional, García-Vidal, C., additional, Muñoz, P., additional, Bergas, A., additional, Pomares, H., additional, Mercadal, S., additional, Durà-Miralles, X., additional, García-Lerma, E., additional, Pallarès, N., additional, and Carratalà, J., additional

Published
2021
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38. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia

Author

Perez-Nadales, E., Gutierrez-Gutierrez, B., Natera, A. M., Abdala, E., Reina Magalhaes, M., Mularoni, A., Monaco, F., Camera Pierrotti, L., Pinheiro Freire, M., Iyer, R. N., Mehta Steinke, S., Grazia Calvi, E., Tumbarello, M., Falcone, M., Fernandez-Ruiz, M., Costa-Mateo, J. M., Rana, M. M., Mara Varejao Strabelli, T., Paul, M., Carmen Farinas, M., Clemente, W. T., Roilides, E., Munoz, P., Dewispelaere, L., Loeches, B., Lowman, W., Hock Tan, B., Escudero-Sanchez, R., Bodro, M., Antonio Grossi, P., Soldani, F., Gunseren, F., Nestorova, N., Pascual, A., Martinez-Martinez, L., Aguado, J., Rodriguez-Bano, J., Torre-Cisneros, J., Wan Song, A. T., Andraus, W., Carneiro D'Albuquerque, L. A., David-Neto, E., Jota de Paula, F., Rossi, F., Ostrander, D., Avery, R., Rizzi, M., Losito, A. R., Raffaelli, F., Del Giacomo, P., Tiseo, G., Lora-Tamayo, J., San-Juan, R., Gracia-Ahufinger, I., Caston, J., Ruiz, Y. A., Altman, D. R., Campos, S. V., Bar-Sinai, N., Koppel, F., Arnaiz de las Revillas Almajano, F., Gonzalez Rico, C., Fernandez Martinez, M., Mourao, P. H. O., Neves, F. A., Ferreira, J., Pyrpasopoulou, A., Iosifidis, E., Romiopoulos, I., Minero, M. V., Sanchez-Carrillo, C., Lardo, S., Coussement, J., Dodemont, M., Jiayun, K., Martin-Davila, P., Fortun, J., Almela, M., Moreno, A., Linares, L., Gasperina, D. D., Balsamo, M. L., Rovelli, C., Concia, E., Chiesi, S., Salerno, D. N., Ogunc, D., Pilmis, B., Seminari, E. M., Carratala, J., Dominguez, A., Cordero, E., Lepe, J. A., Montejo, M., Merino de Lucas, E., Eriksson, B. M., van Delden, C., Manuel, O., Arslan, H., Kocak Tufan, Z., Kazak, E., David, M., Lease, E., Cornaglia, G., Akova, M., European Commission, Ministerio de Ciencia, Innovación y Universidades (España), Instituto de Salud Carlos III, and Universidad de Cantabria

Subjects
medicine.medical_specialty, Combination therapy, infectious disease, 030230 surgery, Settore MED/17 - MALATTIE INFETTIVE, Logistic regression, clinical research/practice, 03 medical and health sciences, 0302 clinical medicine, infection and infectious agents - bacterial, Internal medicine, medicine, Immunology and Allergy, Pharmacology (medical), organ transplantation in general, Infection and infectious agents - bacterial, Transplantation, Infectious disease, Receiver operating characteristic, business.industry, Hazard ratio, Confidence interval, Organ transplantation in general, antibiotic drug resistance, Cohort, Clinical research/practice, Antibiotic drug resistance, business, Cohort study
Abstract

Treatment of carbapenemase‐producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase‐producing Enterobacterales bloodstream infections. A multinational, retrospective (2004‐2016) cohort study (INCREMENT‐SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30‐day all‐cause mortality. The INCREMENT‐SOT‐CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT‐CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT‐CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76‐0.88) and classified patients into 3 strata: 0‐7 (low mortality), 8‐11 (high mortality), and 12‐17 (very‐high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very‐high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13‐7.06, P = .03) and high (HR 9.93, 95% CI 2.08‐47.40, P = .004) mortality risk strata. A score‐based algorithm is provided for therapy guidance., This work was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0008; RD16/0016/0001, RD16/0016/0002, RD16/0016/00010] ‐ co‐financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014‐2020; ESCMID Study Group for Infections in Compromised Hosts [ESGICH grant to JMA]; Sociedad Andaluza de Trasplante de Órgano Sólido [SATOT grant to LMM]; ESCMID Study Group for Bloodstream Infections and Sepsis (ESGBIS); and ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS).

Published
2020

39. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia

Author

Perez-Nadales E, Gutierrez-Gutierrez B, Natera A, Abdala E, Magalhaes M, Mularoni A, Monaco F, Pierrotti L, Freire M, Iyer R, Steinke S, Calvi E, Tumbarello M, Falcone M, Fernandez-Ruiz M, Costa-Mateo J, Rana M, Strabelli T, Paul M, Farinas M, Clemente W, Roilides E, Munoz P, Dewispelaere L, Loeches B, Lowman W, Tan B, Escudero-Sanchez R, Bodro M, Grossi P, Soldani F, Gunseren F, Nestorova N, Pascual A, Martinez-Martinez L, Aguado J, Rodriguez-Bano J, Torre-Cisneros J, Song A, Andraus W, D'Albuquerque L, David-Neto E, de Paula F, Rossi F, Ostrander D, Avery R, Rizzi M, Losito A, Raffaelli F, Del Giacomo P, Tiseo G, Lora-Tamayo J, San-Juan R, Gracia-Ahufinger I, Caston J, Ruiz Y, Altman D, Campos S, Bar-Sinai N, Koppel F, Almajano F, Rico C, Martinez M, Mourao P, Neves F, Ferreira J, Pyrpasopoulou A, Iosifidis E, Romiopoulos I, Minero M, Sanchez-Carrillo C, Lardo S, Coussement J, Dodemont M, Jiayun K, Martin-Davila P, Fortun J, Almela M, Moreno A, Linares L, Gasperina D, Balsamo M, Rovelli C, Concia E, Chiesi S, Salerno D, Ogunc D, Pilmis B, Seminari E, Carratala J, Dominguez A, Cordero E, Lepe J, Montejo M, de Lucas E, Eriksson B, van Delden C, Manuel O, Arslan H, Tufan Z, Kazak E, David M, Lease E, Cornaglia G, Akova M, REIPI INCREMENT-SOT Investigators, Swiss Transplant Cohort Study, and ESGARS-ESCMID Study Grp Antimicrob

Subjects
infection and infectious agents - bacterial, clinical research, infectious disease, antibiotic drug resistance, organ transplantation in general, practice
Abstract

Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score >= 8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score >= 8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.

Published
2020

40. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales : The impact of cytomegalovirus disease and lymphopenia

Author

Perez-Nadales, Elena, Gutierrez-Gutierrez, Belen, Natera, Alejandra M., Abdala, Edson, Magalhaes, Maira Reina, Mularoni, Alessandra, Monaco, Francesco, Pierrotti, Ligia Camera, Freire, Maristela Pinheiro, Iyer, Ranganathan N., Steinke, Seema Mehta, Calvi, Elisa Grazia, Tumbarello, Mario, Falcone, Marco, Fernandez-Ruiz, Mario, Maria Costa-Mateo, Jose, Rana, Meenakshi M., Varejao Strabelli, Tania Mara, Paul, Mical, Carmen Farinas, Maria, Clemente, Wanessa Trindade, Roilides, Emmanuel, Munoz, Patricia, Dewispelaere, Laurent, Loeches, Belen, Lowman, Warren, Tan, Ban Hock, Escudero-Sanchez, Rosa, Bodro, Marta, Grossi, Paolo Antonio, Soldani, Fabio, Gunseren, Filiz, Nestorova, Nina, Pascual, Alvaro, Martinez-Martinez, Luis, Maria Aguado, Jose, Rodriguez-Bano, Jesus, Torre-Cisneros, Julian, Song, A. T. Wan, Andraus, W., Carneiro D'Albuquerque, L. A., David-Neto, E., de Paula, F. Jota, Rossi, F., Ostrander, D., Avery, R., Rizzi, M., Losito, A. R., Raffaelli, F., Del Giacomo, P., Tiseo, G., Lora-Tamayo, J., San-Juan, R., Gracia-Ahufinger, I, Caston, J., Ruiz, Y. A., Altman, D. R., Campos, S. , V, Bar-Sinai, N., Koppel, F., de las Revillas Almajano, F. Arnaiz, Gonzalez Rico, C., Fernandez Martinez, M., Mourao, P. H. O., Neves, F. A., Ferreira, J., Pyrpasopoulou, A., Iosifidis, E., Romiopoulos, I, Minero, M. , V, Sanchez-Carrillo, C., Lardo, S., Coussement, J., Dodemont, M., Jiayun, K., Martin-Davila, P., Fortun, J., Almela, M., Moreno, A., Linares, L., Gasperina, D. D., Balsamo, M. L., Rovelli, C., Concia, E., Chiesi, S., Salerno, D. N., Ogunc, D., Pilmis, B., Seminari, E. M., Carratala, J., Dominguez, A., Cordero, E., Lepe, J. A., Montejo, M., Merino de Lucas, E., Eriksson, Britt-Marie, van Delden, C., Manuel, O., Arslan, H., Tufan, Z. Kocak, Kazak, E., David, M., Lease, E., Cornaglia, G., Akova, M., Perez-Nadales, Elena, Gutierrez-Gutierrez, Belen, Natera, Alejandra M., Abdala, Edson, Magalhaes, Maira Reina, Mularoni, Alessandra, Monaco, Francesco, Pierrotti, Ligia Camera, Freire, Maristela Pinheiro, Iyer, Ranganathan N., Steinke, Seema Mehta, Calvi, Elisa Grazia, Tumbarello, Mario, Falcone, Marco, Fernandez-Ruiz, Mario, Maria Costa-Mateo, Jose, Rana, Meenakshi M., Varejao Strabelli, Tania Mara, Paul, Mical, Carmen Farinas, Maria, Clemente, Wanessa Trindade, Roilides, Emmanuel, Munoz, Patricia, Dewispelaere, Laurent, Loeches, Belen, Lowman, Warren, Tan, Ban Hock, Escudero-Sanchez, Rosa, Bodro, Marta, Grossi, Paolo Antonio, Soldani, Fabio, Gunseren, Filiz, Nestorova, Nina, Pascual, Alvaro, Martinez-Martinez, Luis, Maria Aguado, Jose, Rodriguez-Bano, Jesus, Torre-Cisneros, Julian, Song, A. T. Wan, Andraus, W., Carneiro D'Albuquerque, L. A., David-Neto, E., de Paula, F. Jota, Rossi, F., Ostrander, D., Avery, R., Rizzi, M., Losito, A. R., Raffaelli, F., Del Giacomo, P., Tiseo, G., Lora-Tamayo, J., San-Juan, R., Gracia-Ahufinger, I, Caston, J., Ruiz, Y. A., Altman, D. R., Campos, S. , V, Bar-Sinai, N., Koppel, F., de las Revillas Almajano, F. Arnaiz, Gonzalez Rico, C., Fernandez Martinez, M., Mourao, P. H. O., Neves, F. A., Ferreira, J., Pyrpasopoulou, A., Iosifidis, E., Romiopoulos, I, Minero, M. , V, Sanchez-Carrillo, C., Lardo, S., Coussement, J., Dodemont, M., Jiayun, K., Martin-Davila, P., Fortun, J., Almela, M., Moreno, A., Linares, L., Gasperina, D. D., Balsamo, M. L., Rovelli, C., Concia, E., Chiesi, S., Salerno, D. N., Ogunc, D., Pilmis, B., Seminari, E. M., Carratala, J., Dominguez, A., Cordero, E., Lepe, J. A., Montejo, M., Merino de Lucas, E., Eriksson, Britt-Marie, van Delden, C., Manuel, O., Arslan, H., Tufan, Z. Kocak, Kazak, E., David, M., Lease, E., Cornaglia, G., and Akova, M.

Abstract

Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score >= 8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score >= 8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.

Published
2020
Full Text
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41. Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

Author

Bus, L. De, Depuydt, P., Steen, J. van der, Dhaese, S., Smet, K. De, Tabah, A., Akova, M., Cotta, M.O., Pascale, G. De, Dimopoulos, G., Fujitani, S., Garnacho-Montero, J., Leone, M., Lipman, J., Ostermann, M., Paiva, J.A., Schouten, J.A., Sjövall, F., Timsit, J.F., Roberts, J.A., Zahar, J.R., Zand, F., Zirpe, K., Waele, J.J. De, Bus, L. De, Depuydt, P., Steen, J. van der, Dhaese, S., Smet, K. De, Tabah, A., Akova, M., Cotta, M.O., Pascale, G. De, Dimopoulos, G., Fujitani, S., Garnacho-Montero, J., Leone, M., Lipman, J., Ostermann, M., Paiva, J.A., Schouten, J.A., Sjövall, F., Timsit, J.F., Roberts, J.A., Zahar, J.R., Zand, F., Zirpe, K., and Waele, J.J. De

Abstract

Contains fulltext : 225430.pdf (Publisher’s version ) (Open Access), PURPOSE: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. METHODS: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. RESULTS: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60-1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14-1.64). CONCLUSION: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.

Published
2020

42. Antimicrobial Stewardship in Hematological Patients at the intensive care unit: a global cross-sectional survey from the Nine-i Investigators Network

Author

Rello J., Sarda C., Mokart D., Arvaniti K., Akova M., Tabah A., Azoulay E, Montini, Luca, Montini L (ORCID:0000-0003-4602-5134), Rello J., Sarda C., Mokart D., Arvaniti K., Akova M., Tabah A., Azoulay E, Montini, Luca, and Montini L (ORCID:0000-0003-4602-5134)

Abstract

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.

Published
2020

43. Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

Author

De Bus, L., Depuydt, P., Steen, J., Dhaese, S., De Smet, K., Tabah, A., Akova, M., Cotta, M. O., De Pascale, Gennaro, Dimopoulos, G., Fujitani, S., Garnacho-Montero, J., Leone, M., Lipman, J., Ostermann, M., Paiva, J. -A., Schouten, J., Sjovall, F., Timsit, J. -F., Roberts, J. A., Zahar, J. -R., Zand, F., Zirpe, K., De Waele, J. J., Rios, F., Vazquez, A. R., Vidal, M. G., Zakalik, G., Attokaran, A. G., Banakh, I., Dey-Chatterjee, S., Ewan, J., Ferrier, J., Forbes, L., Fourie, C., Leditschke, A., Murray, L., Eller, P., Biston, P., Bracke, S., De Crop, L., De Schryver, N., Frans, E., Spapen, H., Van Malderen, C., Vansteelandt, S., Vermeiren, D., Arevalo, E. P., Crespo, M., Flores, R. Z., Piza, P., Tutillo, D. M., Elme, A., Kallaste, A., Starkopf, J., Bourenne, J., Calypso, M., Cohen, Y., Dahyot-Fizelier, C., Depret, F., Guillot, M., Imzi, N., Jochmans, S., Kouatchet, A., Lepape, A., Martin, O., Heim, M., Schaller, S. J., Arvaniti, K., Bekridelis, A., Ioannidis, P., Mitrakos, C., Papanikolaou, M. N., Pouriki, S., Vemvetsou, A., Abraham, B., Bhattacharya, P. K., Budugu, A., Dixit, S., Gurav, S., Kandanuri, P., Prabhu, D. A., Rathod, D., Savaru, K., Udupa, A. N., Varghese, S. B., Bakhodaei, H. H., Dabiri, G., Fallahi, M. J., Feiz, F., Firoozifar, M., Khaloo, V., Maghsudi, B., Masjedi, M., Nikandish, R., Sabetian, G., Marsh, B., Martin-Loeches, I., Steiner, J., Barbagallo, M., Caricato, Anselmo, Cortegiani, A., D'Andrea, R., Deana, C., Donati, A., Girardis, M., Mandala, G., Panarello, G., Pasero, D., Pelagalli, L., Soave, Paolo Maurizio, Spadaro, S., Fujita, Y., Fujiwara, S., Hara, Y., Hashi, H., Hashimoto, S., Hashimoto, H., Hayakawa, K., Inoue, M., Isokawa, S., Kameda, S., Kamohara, H., Kanamoto, M., Katayama, S., Kawagishi, T., Kawano, Y., Kida, Y., Kita, M., Kobayashi, A., Kuriyama, A., Naito, T., Nashiki, H., Nishiyama, K., Shindo, S., Suzuki, T., Takaba, A., Tanaka, C., Tetsuya, K., Tomioka, Y., Yanagawa, Y., Yoshida, H., Adnan, S., Hasan, M. S., Sulaiman, H., Gasca Lopez, G. A., Hernandez-Cardenas, C. M., Namendys-Silva, S. A., Bethlehem, C., de Lange, D., Hunfeld, N., Numan, S., van Leeuwen, H., Owens, D., Almeida, M., Fragoso, E., Leonor, T., Pereira, J. -M., Filipescu, D., Grigoras, I., Popescu, M., Tomescu, D., Alshahrani, M. S., Alvarez-Gonzalez, M., Barrero-Garcia, I., Blasco-Navalpotro, M. A., Claverias, L., Estella, A., Espina, L. F., Garmendia, J. L. G., Prieto, E. G., Gomez-Prieto, G., Conde, C. J., Sagasti, F. M., Cantero, A. M., Orejas-Gallego, A., Papiol, E., Perez-Civantos, D., Laderas, J. C. P., Alvarez, J. T., Vera-Artazcoz, P., Cortes, P. V., Oldner, A., Spangfors, M., Alp, E., Koksal, I., Korten, V., Ozveren, A., Hall, A., Hatton, K. W., Laudanski, K., De Pascale G. (ORCID:0000-0002-8255-0676), Caricato A. (ORCID:0000-0001-5929-120X), Soave P. M., De Bus, L., Depuydt, P., Steen, J., Dhaese, S., De Smet, K., Tabah, A., Akova, M., Cotta, M. O., De Pascale, Gennaro, Dimopoulos, G., Fujitani, S., Garnacho-Montero, J., Leone, M., Lipman, J., Ostermann, M., Paiva, J. -A., Schouten, J., Sjovall, F., Timsit, J. -F., Roberts, J. A., Zahar, J. -R., Zand, F., Zirpe, K., De Waele, J. J., Rios, F., Vazquez, A. R., Vidal, M. G., Zakalik, G., Attokaran, A. G., Banakh, I., Dey-Chatterjee, S., Ewan, J., Ferrier, J., Forbes, L., Fourie, C., Leditschke, A., Murray, L., Eller, P., Biston, P., Bracke, S., De Crop, L., De Schryver, N., Frans, E., Spapen, H., Van Malderen, C., Vansteelandt, S., Vermeiren, D., Arevalo, E. P., Crespo, M., Flores, R. Z., Piza, P., Tutillo, D. M., Elme, A., Kallaste, A., Starkopf, J., Bourenne, J., Calypso, M., Cohen, Y., Dahyot-Fizelier, C., Depret, F., Guillot, M., Imzi, N., Jochmans, S., Kouatchet, A., Lepape, A., Martin, O., Heim, M., Schaller, S. J., Arvaniti, K., Bekridelis, A., Ioannidis, P., Mitrakos, C., Papanikolaou, M. N., Pouriki, S., Vemvetsou, A., Abraham, B., Bhattacharya, P. K., Budugu, A., Dixit, S., Gurav, S., Kandanuri, P., Prabhu, D. A., Rathod, D., Savaru, K., Udupa, A. N., Varghese, S. B., Bakhodaei, H. H., Dabiri, G., Fallahi, M. J., Feiz, F., Firoozifar, M., Khaloo, V., Maghsudi, B., Masjedi, M., Nikandish, R., Sabetian, G., Marsh, B., Martin-Loeches, I., Steiner, J., Barbagallo, M., Caricato, Anselmo, Cortegiani, A., D'Andrea, R., Deana, C., Donati, A., Girardis, M., Mandala, G., Panarello, G., Pasero, D., Pelagalli, L., Soave, Paolo Maurizio, Spadaro, S., Fujita, Y., Fujiwara, S., Hara, Y., Hashi, H., Hashimoto, S., Hashimoto, H., Hayakawa, K., Inoue, M., Isokawa, S., Kameda, S., Kamohara, H., Kanamoto, M., Katayama, S., Kawagishi, T., Kawano, Y., Kida, Y., Kita, M., Kobayashi, A., Kuriyama, A., Naito, T., Nashiki, H., Nishiyama, K., Shindo, S., Suzuki, T., Takaba, A., Tanaka, C., Tetsuya, K., Tomioka, Y., Yanagawa, Y., Yoshida, H., Adnan, S., Hasan, M. S., Sulaiman, H., Gasca Lopez, G. A., Hernandez-Cardenas, C. M., Namendys-Silva, S. A., Bethlehem, C., de Lange, D., Hunfeld, N., Numan, S., van Leeuwen, H., Owens, D., Almeida, M., Fragoso, E., Leonor, T., Pereira, J. -M., Filipescu, D., Grigoras, I., Popescu, M., Tomescu, D., Alshahrani, M. S., Alvarez-Gonzalez, M., Barrero-Garcia, I., Blasco-Navalpotro, M. A., Claverias, L., Estella, A., Espina, L. F., Garmendia, J. L. G., Prieto, E. G., Gomez-Prieto, G., Conde, C. J., Sagasti, F. M., Cantero, A. M., Orejas-Gallego, A., Papiol, E., Perez-Civantos, D., Laderas, J. C. P., Alvarez, J. T., Vera-Artazcoz, P., Cortes, P. V., Oldner, A., Spangfors, M., Alp, E., Koksal, I., Korten, V., Ozveren, A., Hall, A., Hatton, K. W., Laudanski, K., De Pascale G. (ORCID:0000-0002-8255-0676), Caricato A. (ORCID:0000-0001-5929-120X), and Soave P. M.

Abstract

Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60–1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14–1.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.

Published
2020

44. A clinical predictive model of multidrug resistance in neutropenic cancer patients with bloodstream infection due to Pseudomonas aeruginosa (IRONIC study)

Author

Ciències Mèdiques Bàsiques, Universitat Rovira i Virgili, Gudiol C, Albasanz-Puig A, Laporte-Amargós J, Pallarès N, Mussetti A, Ruiz-Camps I, Puerta-Alcalde P, Abdala E, Oltolini C, Akova M, Montejo M, Mikulska M, Martín-Dávila P, Herrera F, Gasch O, Drgona L, Paz Morales H, Brunel AS, García E, Isler B, Kern WV, Morales I, Maestro-de la Calle G, Montero M, Kanj SS, Sipahi OR, Calik S, Márquez-Gómez I, Marin JI, Gomes MZR, Hemmatti P, Araos R, Peghin M, Del Pozo JL, Yáñez L, Tilley R, Manzur A, Novo A, Carratalà J, IRONIC Study Group, Ciències Mèdiques Bàsiques, Universitat Rovira i Virgili, and Gudiol C, Albasanz-Puig A, Laporte-Amargós J, Pallarès N, Mussetti A, Ruiz-Camps I, Puerta-Alcalde P, Abdala E, Oltolini C, Akova M, Montejo M, Mikulska M, Martín-Dávila P, Herrera F, Gasch O, Drgona L, Paz Morales H, Brunel AS, García E, Isler B, Kern WV, Morales I, Maestro-de la Calle G, Montero M, Kanj SS, Sipahi OR, Calik S, Márquez-Gómez I, Marin JI, Gomes MZR, Hemmatti P, Araos R, Peghin M, Del Pozo JL, Yáñez L, Tilley R, Manzur A, Novo A, Carratalà J, IRONIC Study Group

Abstract

Background: We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa (PA) in neutropenic cancer patients.Methods: We performed a multicenter, retrospective cohort study including onco-hematological neutropenic patients with BSI due to PA conducted across 34 centers in 12 countries from January 2006 to May 2018. A mixed logistic regression model was used to estimate a model to predict multidrug resistance of the causative pathogens.Results: Of a total of 1217 episodes of BSI due to PA, 309 episodes (25.4%) were caused by MDR strains. The rate of multidrug resistance increased significantly over the study period (p=0.033). Predictors of MDRPA BSI were prior therapy with piperacillin/tazobactam (odds ratio [OR], 3.48; 95% confidence interval [CI], 2.29-5.30), prior antipseudomonal carbapenem use (OR, 2.53; 95% CI, 1.65-3.87), fluoroquinolone prophylaxis (OR, 2.99; 95% CI, 1.92-4.64), underlying hematological disease (OR, 2.09 95% CI, 1.26-3.44) and the presence of a urinary catheter (OR, 2.54; 95% CI, 1.65-3.91), whereas older age (OR, 0.98; 95% CI, 0.97-0.99) was found to be protective.Conclusions: Our prediction model achieves good discrimination and calibration, thereby identifying neutropenic patients at higher risk of BSI due to MDRPA. The application of this model using a web-based calculator may be a simple strategy to identify high-risk patients, who may benefit from the early administration of a broad-spectrum antibiotic coverage against MDR strains according to the local susceptibility patterns, thus avoiding the use of broad-spectrum antibiotics in patients at low risk of resistance.Copyright © 2020 American Society for Microbiology.

Published
2020

47. Performance of existing definitions and tests for the diagnosis of invasive aspergillosis in critically ill, adult patients: A systematic review with qualitative evidence synthesis

Author

Bassetti, M., primary, Giacobbe, D.R., additional, Grecchi, C., additional, Rebuffi, C., additional, Zuccaro, V., additional, Scudeller, L., additional, Akova, M., additional, Alastruey-Izquierdo, A., additional, Arikan-Akdagli, S., additional, Azoulay, E., additional, Blot, S., additional, Cornely, O.A., additional, Lass-Flörl, C., additional, Koehler, P., additional, Cuenca-Estrella, M., additional, de Lange, D.W., additional, De Rosa, F.G., additional, De Waele, J.J., additional, Dimopoulos, G., additional, Garnacho-Montero, J., additional, Hoenigl, M., additional, Kanj, S.S., additional, Lamoth, F., additional, Maertens, J., additional, Martin-Loeches, I., additional, Muñoz, P., additional, Kullberg, B.J., additional, Agvald-Ohman, C., additional, Poulakou, G., additional, Rello, J., additional, Righi, E., additional, Sanguinetti, M., additional, Taccone, F.S., additional, Timsit, J-F., additional, Torres, A., additional, Vazquez, J.A., additional, Wauters, J., additional, Calandra, T., additional, Asperges, E., additional, Tejada, S., additional, Lebihan, C., additional, Karaiskos, I., additional, Peghin, M., additional, Mortensen, K.L., additional, Vena, A., additional, Cortegiani, A., additional, and Mercier, T., additional

Published
2020
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50. External validation of the INCREMENT-CPE mortality score in a carbapenem-resistant Klebsiella pneumoniae bacteraemia cohort: the prognostic significance of colistin resistance

Author

Machuca, I, Gutierrez-Gutierrez, B, Rivera-Espinar, F, Cano, A, Gracia-Ahufinger, I, Guzman-Puche, J, Marfil-Perez, E, Perez-Nadales, E, Caston, JJ, Bonomo, RA, Carmeli, Y, Paterson, D, Pascual, A, Martinez-Martinez, L, Rodriguez-Bano, J, Torre-Cisneros, J, Salamanca, E, de Cueto, M, Hsueh, PR, Viale, P, Bartoletti, M, Giannella, M, Pano-Pardo, JR, Mora-Rillo, M, Navarro-San Francisco, C, Venditti, M, Falcone, M, Russo, A, Tumbarello, M, Trecarichi, EM, Losito, AR, Daikos, G, Skiada, A, Canton, R, Pintado, V, Ruiz, P, Doi, Y, Tuon, FF, Karaiskos, I, Giamarellou, H, Schwaber, MJ, Azap, OK, Souli, M, Antoniadou, A, Poulakou, G, Roilides, E, Iosifidis, E, Pournaras, S, Tsakris, A, Zarkotou, O, Akova, M, Helvaci, O, Sahin, AO, Perez, F, Bermejo, J, Rucci, V, Oliver, A, de Gopegui, ER, Marinescu, CI, de la Calle, C, Martinez, JA, Morata, L, Soriano, A, Lowman, W, Almirante, B, Larrosa, N, Puig-Asensio, M, Garcia-Vazquez, E, Hernandez, A, Gomez, J, Bou, G, Prim, N, Navarro, F, Mirelis, B, Origuen, J, San Juan, R, Fernandez-Ruiz, M, Cisneros, JM, Molina, J, Gonzalez, V, Farinas, MC, Cano, ME, Gozalo, M, Pena, C, Gomez-Zorrilla, S, Tubau, F, Pitout, J, Virmani, D, Natera, C, Marfil, E, Tacconelli, E, Riemenschneider, F, Calbo, E, Badia, C, Xercavins, M, Gasch, O, Fontanals, D, and Jove, E

Subjects
KPC, Klebsiella pneumoniae, Carbapenem resistance, INCREMENT risk score, Colistin resistance
Abstract

External validation of the INCREMENT-CPE risk score (ICS) for 30-day all-cause mortality is needed. There is also scarce information about whether colistin resistance influences the prognosis of carbapenem-resistant Klebsiella pneumoniae (CRKp) bacteraemia. In this study, the ability of ICS to predict all-cause mortality in the KAPECOR cohort was calculated using the area under the receiver operating characteristic (AUROC) curve. The association of colistin resistance with mortality was studied. The ICS showed an AUROC curve of 0.77 (95% CI 0.68-0.86). A cut-off of 8 points showed 96.8% sensitivity and 50.7% specificity. Mortality of low-risk patients was not different in those treated with monotherapy versus combination therapy. However, mortality of high-risk patients treated with combination therapy (37.8%) was significantly lower than in those treated with monotherapy (68.4%) (P = 0.008). To study the prognostic significance of colistin resistance, 83 selected cases of bacteraemia due to colistin-susceptible CRKp were obtained from the INCREMENT cohort for comparison. Colistin resistance could not be shown to be associated with higher mortality in either the high-risk ICS group [adjusted odds ratio (aOR) = 1.56, 95% CI 0.69-3.33; P = 0.29] or in 37 ICS-matched pairs (aOR = 1.38, 95% CI 0.55-3.42; P = 0.49), or in a sensitivity analysis including only KPC isolates (aOR = 1.81, 95% CI 0.73-4.57; P = 0.20), but the precision of estimates was low. These results validate ICS for all-cause mortality and to optimise targeted therapy for CRKp bacteraemia. Colistin resistance was not clearly associated with increased mortality. (C) 2019 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Published
2019

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