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1. Changes in bodyweight after initiating antiretroviral therapy close to HIV-1 seroconversion: an international cohort collaboration

Author

Pantazis, Nikos, Sabin, Caroline A, Grabar, Sophie, Van der Valk, Marc, Jarrin, Inma, van Sighem, Ard, Meyer, Laurence, Carlander, Christina, Gill, John, Volny Anne, Alain, Spire, Bruno, Tariq, Shema, Burns, Fiona, Costagliola, Dominique, Ruiz-Burga, Elisa, Touloumi, Giota, Porter, Kholoud, Moreno, Santiago, Burns, Fiona, Campo, Rafael Eduardo, Garges, Harmony, Mussini, Cristina, Pantazis, Nikos, Kamel, Moustafa, Porter, Kholoud, Sabin, Caroline, Tariq, Shema, Touloumi, Giota, Vannappagari, Vani, Anne, Alain Volny, Young, Lital, Gill, John, Carlander, Christina, Grabar, Sophie, Jarrín, Inma, Meyer, Laurence, van der Valk, Marc, Wittkop, Linda, Aisam, Agnes, Barger, Diana, Davidovich, Udi, Dos Santos, Marie, Eriksson, Lars, Fitzgerald, Eli, Karakosta, Argyro, Krentz, Hartmut, Nicholls, Emily Jay, Policek, Nicoletta, Ruiz-Burga, Elisa, Sandford, Chris, Spire, Bruno, Suárez-García, Inés, Abgrall, Sophie, Andriantsoanirina, Valerie, Avettand-Fenoel, Veronique, Bourgeois, Christine, Chaix, Marie-Laure, Cheret, Antoine, Fischer, Hugues, Goujard, Cecile, Lascoux-Combe, Caroline, Le Palec, Annie, Petrov-Sanchez, Ventzlislava, Saez-Cirion, Asier, Seng, Remonie, Stefic, Karl, Tine, Josephine, Piet, E, Gagneux-Brunon, A, Jacomet, C, Piroth, L, Benezit, F, Goussef, M, Tattevin, P, Bani Sadr, B, Lamaury, I, Bazus, H, Robineau, O, Calin, R, Katlama, J, Denis, B, Ghosn, J, Joly, V, Khuong, M A, Caby, F C, Rouveix Nordon, E, de Truchis, P, Abgrall, S, Chéret, A, Duvivier, C, Becker, A, Miailhes, P, Abel, S, Unal, G, Makinson, A, Martin-Blondel, G, Morisot, A, Bregigeon, S, Enel, P, Allavena, C, Rabier, V, Vallet, L, Marchand, L, Saïdi, T, Costagliola, D, Grabar, S, Piet, E, Andriantsoanirina, V, Rabier, V, Fischer, H, Vallet, L, Marchand T Saïdi, L, Costagliola, D, Grabar, S, Abgrall, Sophie, Tattevin, Pierre, de Truchis, Pierre, Fischer, Hughes, Grabar, Sophie, Moreno, Santiago, Jarrín, Inma, Dalmau, David, Navarro, M Luisa, González, M Isabel, Garcia, Federico, Poveda, Eva, Iribarren, Jose Antonio, Gutiérrez, Félix, Rubio, Rafael, Vidal, Francesc, Berenguer, Juan, Muñoz-Fernández, M Ángeles, Adamis, G, Chini, M, Chrysos, G, Marangos, M, Katsarou, O, Kofteridis, D, Metallidis, S, Panagopoulos, P, Papadopoulos, A, Paparizos, V, Psychogiou, M, Sambatakou, H, Sipsas, N V, Touloumi, G, Fox, Julie, Terry, Louise, Waters, Anele, Uriel, Alison, Ustianowski, Andrew, Hackney, Pamela, Fahd, Niaz, Fidler, Sarah, Ayap, Wilbert, Molina, Marcelino, Waters, Laura, Nur, Fowsiya, Fernandez, Thomas, Nugent, Diarmuid, Pinedo, Javier, Reeves, Iain, Fong, Tracy, Nicholls, Jane, Cunningham, Laura, Pangan, Jaydee, Mackintosh, Claire, and Sharp, Louise

Abstract

Understanding the reasons for and consequences of bodyweight change in people living with HIV initiating antiretroviral therapy (ART) is crucial to optimising long-term health and wellbeing. We aimed to examine bodyweight trends and associated factors among individuals with well estimated dates of HIV-1 seroconversion.

Published
2024
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2. ESCMID generic competencies in antimicrobial prescribing and stewardship: towards a European consensus

Author

Ashiru-Oredope, D., Barcs, I., Blix, H.S., Buyle, F., Chowers, M., Čižman, M., Cookson, B., Del Pozo, J.L., Deptula, A., Dumpis, U., Florea, D., van de Garde, E., Geffen, Y., Giske, C.G., Grau, S., Hajdú, E., Hell, M., Hondo, Ł., Hussein, K., Huttner, B., Kern, W., Kernéis, S., Knepper, V., Kofteridis, D., Kostyanev, T., Kuijper, E., Lebanova, H., Lewis, R., Cordina, C.M., Matulionyte, R., Maurer, F., Messiaen, P., Miciuleviciene, J., Mrhar, A., Nabuurs-Franssen, M., Naesens, R., Oxacelay, C., Pagani, L., Paño-Pardo, J.R., Paul, M., Petrikkos, G., Pluess-Suard, C., Popescu, G.A., Porsche, U., Prins, J., Pulcini, C., Rello, J., Rodríguez-Baño, J., Rossolini, G.M., Salzberger, B., Seme, K., Simonsen, G.S., Sînziana, M., Skovgaard, S., Smith, I., Sönsken, U., Soriano, A., Sviestiņa, I., Szilagyi, E., Tängdén, T., Tattevin, P., Tsioutis, C., Vilde, A., Wanke-Rytt, M., Wechsler-Fördös, A., Zarb, P., Dyar, O.J., Beović, B., Tacconelli, E., and Hulscher, M.

Published
2019
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3. An analysis of existing national action plans for antimicrobial resistance-gaps and opportunities in strategies optimising antibiotic use in human populations.

Author

Charani, E., Mendelson, M., Pallett, S.J.C., Ahmad, R., Mpundu, M., Mbamalu, O., Bonaconsa, C., Nampoothiri, V., Singh, Sanjeev, Peiffer-Smadja, N., Anton-Vazquez, V., Moore, L.S.P., Schouten, J.A., Kostyanev, T., Vlahović-Palčevski, V., Kofteridis, D., Corrêa, J.S., Holmes, A.H., Charani, E., Mendelson, M., Pallett, S.J.C., Ahmad, R., Mpundu, M., Mbamalu, O., Bonaconsa, C., Nampoothiri, V., Singh, Sanjeev, Peiffer-Smadja, N., Anton-Vazquez, V., Moore, L.S.P., Schouten, J.A., Kostyanev, T., Vlahović-Palčevski, V., Kofteridis, D., Corrêa, J.S., and Holmes, A.H.

Abstract

Item does not contain fulltext, At the 2015 World Health Assembly, UN member states adopted a resolution that committed to the development of national action plans (NAPs) for antimicrobial resistance (AMR). The political determination to commit to NAPs and the availability of robust governance structures to assure sustainable translation of the identified NAP objectives from policy to practice remain major barriers to progress. Inter-country variability in economic and political resilience and resource constraints could be fundamental barriers to progressing AMR NAPs. Although there have been regional and global analyses of NAPs from a One Health and policy perspective, a global assessment of the NAP objectives targeting antimicrobial use in human populations is needed. In this Health Policy, we report a systematic evidence synthesis of existing NAPs that are aimed at tackling AMR in human populations. We find marked gaps and variability in maturity of NAP development and operationalisation across the domains of: (1) policy and strategic planning; (2) medicines management and prescribing systems; (3) technology for optimised antimicrobial prescribing; (4) context, culture, and behaviours; (5) operational delivery and monitoring; and (6) patient and public engagement and involvement. The gaps identified in these domains highlight opportunities to facilitate sustainable delivery and operationalisation of NAPs. The findings from this analysis can be used at country, regional, and global levels to identify AMR-related priorities that are relevant to infrastructure needs and contexts.

Published
2023

5. A prospective, cohort, multicentre study of candidaemia in hospitalized adult patients with haematological malignancies

Author

Gamaletsou, M.N., Walsh, T.J., Zaoutis, T., Pagoni, M., Kotsopoulou, M., Voulgarelis, M., Panayiotidis, P., Vassilakopoulos, T., Angelopoulou, M.K., Marangos, M., Spyridonidis, A., Kofteridis, D., Pouli, A., Sotiropoulos, D., Matsouka, P., Argyropoulou, A., Perloretzou, S., Leckerman, K., Manaka, A., Oikonomopoulos, P., Daikos, G., Petrikkos, G., and Sipsas, N.V.

Published
2014
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6. SARS-CoV-2 load in exhaled end-tidal breath fine aerosol condensates among acutely symptomatic COVID-19 cases

Author

Moschos, S, primary, Jajah, E, additional, Almeida, P, additional, Athanasiou, N, additional, Nikolouzakis, T, additional, Henderson, J, additional, Ali, S, additional, Mantso, T, additional, Kofteridis, D, additional, Zafiropoulos, A, additional, Rokka, C, additional, Queiroz, D, additional, Tsatsakis, A, additional, Katsaounou, P, additional, Kotanidou, A, additional, Lagiou, P, additional, Aguiar, R, additional, Teixeira, M, additional, and Magiorkinis, G, additional

Published
2022
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7. Current clinical practice in antibiotic treatment of Staphylococcus aureus bacteraemia: results from a survey in five European countries

Author

Buis, D T P, primary, Prins, J M, additional, Betica-Radic, L, additional, de Boer, M G J, additional, Ekkelenkamp, M, additional, Kofteridis, D, additional, Peiffer-Smadja, N, additional, Schouten, J, additional, Spernovasilis, N, additional, Tattevin, P, additional, ten Oever, J, additional, and Sigaloff, K C E, additional

Published
2022
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8. Duration of Treatment for Pseudomonas aeruginosa Bacteremia: a Retrospective Study

Author

Babich, T., Naucler, P., Valik, J.K., Giske, C.G., Benito, Natividad, Cardona, R., Rivera, Alba, Pulcini, C., Fattah, M.A., Haquin, J., Macgowan, A., Grier, S., Chazan, B., Yanovskay, A., Ami, R.B., Landes, M., Nesher, L., Zaidman-Shimshovitz, A., McCarthy, K., Paterson, D.L., Tacconelli, E., Buhl, M., Mauer, S., Rodríguez-Baño, J., de Cueto, M., Oliver, A., de Gopegui, E.R., Cano, A., Machuca, I., Gozalo-Marguello, M., Martinez-Martinez, L., Gonzalez-Barbera, E.M., Alfaro, I.G., Salavert, M., Beovic, B., Saje, A., Mueller-Premru, M., Pagani, L., Vitrat, V., Kofteridis, D., Zacharioudaki, M., Maraki, S., Weissman, Y., Paul, M., Dickstein, Y., Leibovici, L., Yahav, D., Universitat Autònoma de Barcelona, and Yahav, Dafna

Subjects
Microbiology (medical), Infectious Diseases, Duration, Antibiotics, Pseudomonas aeruginosa, Bacteremia, Antimicrobial stewardship
Abstract

[Introduction] There is no consensus regarding optimal duration of antibiotic therapy for Pseudomonas aeruginosa bacteremia. We aimed to evaluate the impact of short antibiotic course., [Methods] We present a retrospective multicenter study including patients with P. aeruginosa bacteremia during 2009–2015. We evaluated outcomes of patients treated with short (6–10 days) versus long (11–15 days) antibiotic courses. The primary outcome was a composite of 30-day mortality or bacteremia recurrence and/or persistence. Univariate and inverse probability treatment-weighted (IPTW) adjusted multivariate analysis for the primary outcome was performed. To avoid immortal time bias, the landmark method was used., [Results] We included 657 patients; 273 received a short antibiotic course and 384 a long course. There was no significant difference in baseline characteristics of patients. The composite primary outcome occurred in 61/384 patients in the long-treatment group (16%) versus 32/273 in the short-treatment group (12%) (p = 0.131). Mortality accounted for 41/384 (11%) versus 25/273 (9%) of cases, respectively. Length of hospital stay was significantly shorter in the short group [median 13 days, interquartile range (IQR) 9–21 days, versus median 15 days, IQR 11–26 days, p = 0.002]. Ten patients in the long group discontinued antibiotic therapy owing to adverse events, compared with none in the short group. On univariate and multivariate analyses, duration of therapy was not associated with the primary outcome., [Conclusions] In this retrospective study, 6–10 days of antibiotic course for P. aeruginosa bacteremia were as effective as longer courses in terms of survival and recurrence. Shorter therapy was associated with reduced length of stay and less drug discontinuation.

Published
2022

9. Survey of delivery of parenteral antimicrobials in non-inpatient settings across Europe

Author

Emilie, C., Nocker, P. de, Saïdani, N., Gilchrist, M., Seaton, R.A., Patel, S, Beraud, G., Kofteridis, D., Schouten, J.A., Thilly, N., Berrevoets, M., Hulscher, M.E.J.L., Buyle, F., Pulcini, C., Emilie, C., Nocker, P. de, Saïdani, N., Gilchrist, M., Seaton, R.A., Patel, S, Beraud, G., Kofteridis, D., Schouten, J.A., Thilly, N., Berrevoets, M., Hulscher, M.E.J.L., Buyle, F., and Pulcini, C.

Abstract

Item does not contain fulltext, Delivery of parenteral antimicrobials in non-inpatient settings (DPANS) may be through a dedicated outpatient parenteral antimicrobial therapy (OPAT) service, co-ordinated by hospital- or community-based specialised teams, or via an infusion service involving community-based health professionals (nurses, general practitioners) without centralised hospital oversight, or through ad hoc arrangements. DPANS varies among countries. Our objective was to describe how DPANS is organised at a national level in European countries. A survey (65-item self-administered questionnaire) was conducted from February-June 2019 among infection specialists in 34 European countries on behalf of the ESCMID Study Group for Antimicrobial Stewardship (ESGAP) and the British Society for Antimicrobial Chemotherapy (BSAC) OPAT initiative. Most countries (28/34; 82.4%) participated in the survey. DPANS was available in almost all (27/28; 96.4%) responding countries. DPANS was predominantly provided either via specialised OPAT services (17/28; 60.7%) or via infusion services (16/28; 57.1%), with 11 countries (39.3%) providing both services. A formal OPAT team structure with specifically trained staff was reported in only six countries (6/17; 35.3%). Some countries (4/28; 14.3%) had no structured services but practiced DPANS via ad hoc arrangements. The costs of all stages of the process were covered for patients managed by specialised OPAT/infusion services, either completely, partially or for specific patient groups in the majority (20/28; 71.4%) of countries. The main barriers to implement OPAT/infusion services were lack of organisational structure or guidelines. In conclusion, DPANS with respect to availability and organisation is highly heterogeneous in Europe. National/European guidelines may help improve and standardise DPANS.

Published
2022

10. Current clinical practice in antibiotic treatment of Staphylococcus aureus bacteraemia: results from a survey in five European countries

Author

Buis, D.T.P., Prins, J.M., Betica-Radic, L., Boer, M.G. de, Ekkelenkamp, M., Kofteridis, D., Peiffer-Smadja, N., Schouten, J.A., Spernovasilis, N., Tattevin, P., Oever, J. ten, Sigaloff, K.C., Buis, D.T.P., Prins, J.M., Betica-Radic, L., Boer, M.G. de, Ekkelenkamp, M., Kofteridis, D., Peiffer-Smadja, N., Schouten, J.A., Spernovasilis, N., Tattevin, P., Oever, J. ten, and Sigaloff, K.C.

Abstract

Item does not contain fulltext, OBJECTIVES: To determine clinical practice variation and identify knowledge gaps in antibiotic treatment of Staphylococcus aureus bacteraemia (SAB). METHODS: A web-based survey with questions addressing antibiotic treatment of SAB was distributed through the ESGAP network among infectious disease specialists, clinical microbiologists and internists in Croatia, France, Greece, the Netherlands and the UK between July 2021 and November 2021. RESULTS: A total number of 1687 respondents opened the survey link, of whom 677 (40%) answered at least one question. For MSSA and MRSA bacteraemia, 98% and 94% preferred initial monotherapy, respectively. In patients with SAB and non-removable infected prosthetic material, between 80% and 90% would use rifampicin as part of the treatment. For bone and joint infections, 65%-77% of respondents would consider oral step-down therapy, but for endovascular infections only 12%-32% would. Respondents recommended widely varying treatment durations for SAB with different foci of infection. Overall, 48% stated they used 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG-PET/CT) to guide antibiotic treatment duration. Persistent bacteraemia was the only risk factor for complicated SAB that would prompt a majority to extend treatment from 2 to 4-6 weeks. CONCLUSIONS: This survey in five European countries shows considerable clinical practice variation between and within countries in the antibiotic management of SAB, in particular regarding oral step-down therapy, choice of oral antibiotic agents, treatment duration and use of 18F-FDG-PET/CT. Physicians use varying criteria for treatment decisions, as evidence from clinical trials is often lacking. These areas of practice variation could be used to prioritize future studies for further improvement of SAB care.

Published
2022

11. Current clinical practice in antibiotic treatment of Staphylococcus aureus bacteraemia: results from a survey in five European countries

Author

Epi Infectieziekten Team 1, Infection & Immunity, CDL Staf Patiëntenzorg KC, Zorgeenheid Orthopaedie Medisch, UMC Utrecht Holding, MMB Medische Staf, Buis, D. T.P., Prins, J. M., Betica-Radic, L., de Boer, M. G.J., Ekkelenkamp, M., Kofteridis, D., Peiffer-Smadja, N., Schouten, J., Spernovasilis, N., Tattevin, P., Ten Oever, J., Sigaloff, K. C.E., Epi Infectieziekten Team 1, Infection & Immunity, CDL Staf Patiëntenzorg KC, Zorgeenheid Orthopaedie Medisch, UMC Utrecht Holding, MMB Medische Staf, Buis, D. T.P., Prins, J. M., Betica-Radic, L., de Boer, M. G.J., Ekkelenkamp, M., Kofteridis, D., Peiffer-Smadja, N., Schouten, J., Spernovasilis, N., Tattevin, P., Ten Oever, J., and Sigaloff, K. C.E.

Published
2022

18. Evolution of epidemiological characteristics of infective endocarditis in Greece

Author

Giannitsioti, E. Pefanis, A. Gogos, C. Lekkou, A. Dalekos, G.N. Gatselis, N. Georgiadou, S. Nikou, P. Vrettou, A. Rigopoulos, A. Tryfonopoulos, C. Tsaganos, T. Karofilakis, E. Psarrakis, C. Argyriou, M. Gargalianos-Kakolyris, P. Adamis, G. Lourida, P. Kofteridis, D. Andrianaki, A. Loupa, C. Kostis, E. Sinapidis, D. Sympardi, S. Alexiou, N. Karaiskos, I. Masgala, A. Maltezos, E. Panagopoulos, P. Sachpekidis, V. Evdoridis, C. Sipsas, N.V. Daikos, G. Giamarellou, H. Pontikis, K. Lioris, I. Lelekis, M. Trikkas, A. Aggouras, D. Kolias, V. Rokkas, C. Nana-Anastasiou, M. Miyakis, S. On behalf of the Hellenic Society of Chemotherapy

Abstract

Objective: The clinical profile, management and outcome of infective endocarditis (IE) may be influenced by socioeconomic issues. Methods: A nationwide prospective study evaluated IE during the era of deep economic crisis in Greece. Epidemiological data and factors associated with 60-day mortality were analyzed through descriptive statistics, logistic and Cox-regression models. Results: Among 224 patients (male 72.3%, mean age 62.4 years), Staphylococcus aureus (n = 62; methicillin-resistant S. aureus (MRSA) 33.8%) predominated in the young without impact on mortality (p = 0.593), whilst Enterococci (n = 36) predominated in the elderly. Complications of IE were associated with mortality: heart failure [OR 2.415 (95% CI: 1.159–5.029), p = 0.019], stroke [OR 3.206 (95% CI: 1.190–8.632), p = 0.018] and acute kidney injury [OR 2.283 (95% CI: 1.085–4.805), p = 0.029]. A 60-day survival benefit was solely related to cardiac surgery for IE during hospitalization [HR 0.386 (95% CI: 0.165–0.903), p = 0.028] and compliance with antimicrobial treatment guidelines [HR 0.487 (95% CI: 0.259–0.916), p = 0.026]. Compared with a previous country cohort study, history of rheumatic fever and native valve predisposition had declined, whilst underlying renal disease and right-sided IE had increased (p < 0.0001); HIV infection had emerged (p = 0.002). No difference in rates of surgery and outcome was assessed. Conclusions: A country-wide survey of IE highlighted emergence of HIV, right-sided IE and predominance of MRSA in the youth during a severe socioeconomic crisis. Compliance with treatment guidelines promoted survival. © 2021 The Authors

Published
2021

31. ESCMID generic competencies in antimicrobial prescribing and stewardship: towards a European consensus

Author

Dyar, O.J., primary, Beović, B., additional, Pulcini, C., additional, Tacconelli, E., additional, Hulscher, M., additional, Cookson, B., additional, Ashiru-Oredope, D., additional, Barcs, I., additional, Blix, H.S., additional, Buyle, F., additional, Chowers, M., additional, Čižman, M., additional, Del Pozo, J.L., additional, Deptula, A., additional, Dumpis, U., additional, Florea, D., additional, van de Garde, E., additional, Geffen, Y., additional, Giske, C.G., additional, Grau, S., additional, Hajdú, E., additional, Hell, M., additional, Hondo, Ł., additional, Hussein, K., additional, Huttner, B., additional, Kern, W., additional, Kernéis, S., additional, Knepper, V., additional, Kofteridis, D., additional, Kostyanev, T., additional, Kuijper, E., additional, Lebanova, H., additional, Lewis, R., additional, Cordina, C.M., additional, Matulionyte, R., additional, Maurer, F., additional, Messiaen, P., additional, Miciuleviciene, J., additional, Mrhar, A., additional, Nabuurs-Franssen, M., additional, Naesens, R., additional, Oxacelay, C., additional, Pagani, L., additional, Paño-Pardo, J.R., additional, Paul, M., additional, Petrikkos, G., additional, Pluess-Suard, C., additional, Popescu, G.A., additional, Porsche, U., additional, Prins, J., additional, Rello, J., additional, Rodríguez-Baño, J., additional, Rossolini, G.M., additional, Salzberger, B., additional, Seme, K., additional, Simonsen, G.S., additional, Sînziana, M., additional, Skovgaard, S., additional, Smith, I., additional, Sönsken, U., additional, Soriano, A., additional, Sviestiņa, I., additional, Szilagyi, E., additional, Tängdén, T., additional, Tattevin, P., additional, Tsioutis, C., additional, Vilde, A., additional, Wanke-Rytt, M., additional, Wechsler-Fördös, A., additional, and Zarb, P., additional

Published
2019
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33. Amoxicillin dosing recommendations are very different in European countries: a cross-sectional survey

Author

Pulcini, C., primary, Beovic, B., additional, Cavalié, P., additional, Deptula, A., additional, Dyar, O., additional, Gyssens, I., additional, Kern, W., additional, Knepper, V., additional, Kofteridis, D., additional, Hanberger, H., additional, Huttner, B., additional, Messiaen, P., additional, Pagani, L., additional, Pano Pardo, J., additional, Pulcini, C., additional, Rodriguez-Bano, J., additional, Skov Simonsen, G., additional, Vlahović-Palčevski, V., additional, and Zarb, P., additional

Published
2017
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34. ESGAP inventory of target indicators assessing antibiotic prescriptions: A cross-sectional survey

Author

Howard, P., Huttner, B., Beovic, B., Beraud, G., Kofteridis, D. P., Pardo, J. P., Schouten, J., Pulcini, C., Angioni, G., Arvaniti, K., Barac, A., Bolla, C., Calbo, E., Dyar, O. -J., Fantoni, Massimo, Fjeld, H., Keuleyan, E., Kumar, S., Harhxi, A., Jenkins, D., Maurer, F. P., Messiaen, P., Baranda, M. M., Munoz, P., Orlando, G., Pagani, L., Pepe, F., Gentil, P. R., Pereira, N. M. R., Rodrigues-Bano, J., Skodvin, B., Tangden, T., Vitrat, V., Vlahovic-Palcevski, V., Wechsler-Fordos, A., Zarb, P., Fantoni M. (ORCID:0000-0001-6913-8460), Howard, P., Huttner, B., Beovic, B., Beraud, G., Kofteridis, D. P., Pardo, J. P., Schouten, J., Pulcini, C., Angioni, G., Arvaniti, K., Barac, A., Bolla, C., Calbo, E., Dyar, O. -J., Fantoni, Massimo, Fjeld, H., Keuleyan, E., Kumar, S., Harhxi, A., Jenkins, D., Maurer, F. P., Messiaen, P., Baranda, M. M., Munoz, P., Orlando, G., Pagani, L., Pepe, F., Gentil, P. R., Pereira, N. M. R., Rodrigues-Bano, J., Skodvin, B., Tangden, T., Vitrat, V., Vlahovic-Palcevski, V., Wechsler-Fordos, A., Zarb, P., and Fantoni M. (ORCID:0000-0001-6913-8460)

Abstract

Background A variety of indicators is commonly used to monitor antibiotic prescriptions as part of national antimicrobial stewardship (AMS) programmes. Objectives To make an inventory of indicators that assess antibiotic prescriptions and are linked to specific targets and incentives, at a national level. Methods A cross-sectional survey (three-item questionnaire) was conducted in 2017 among all ESGAP (ESCMID Study Group for Antimicrobial stewardshiP) members, coming from 23 European countries and 16 non-European countries. Results Almost all (20/23, 87%) European countries belonging to the ESGAP network participated, as well as one non-European country. Computerized systems routinely linking antibiotic prescriptions to clinical diagnoses were reported for only two countries (Turkey and Croatia). Only 6/21 (29%) countries had national indicators with both clear targets and incentives (Bulgaria, Croatia, France, the Netherlands, Norway and Portugal). We identified a total of 21 different indicators used in these countries, 16 concerning inpatients (9 quality indicators and 7 quantity metrics) and 8 concerning outpatients (all quantity metrics); some indicators were used in both settings. Three types of incentives were used: financing mechanism, hospitals' accreditation and public reporting. Some respondents reported that such indicators with both clear targets and incentives were used at a regional level in their country (e.g. Andalusia in Spain and England in the UK). Conclusions National indicators, with clear targets and incentives, are not commonly used in Europe and we observed wide variations between countries regarding the selected indicators, the units of measure and the chosen targets.

Published
2017

35. Breakthrough candidaemia caused by phenotypically susceptible Candida spp. in patients with haematological malignancies does not correlate with established interpretive breakpoints

Author

Gamaletsou, M.N. Daikos, G.L. Walsh, T.J. Perlin, D.S. Ortigosa, C.J. Psaroulaki, A. Pagoni, M. Argyropoulou, A. Nepka, M. Perivolioti, E. Kotsopoulou, M. Perloretzou, S. Marangos, M. Kofteridis, D. Grammatikou, M. Goukos, D. Petrikkos, G. Sipsas, N.V.

Abstract

In a study of 27,864 patients with haematological malignancies, 40 patients with candidaemia were identified, among whom 21 developed candidaemia while receiving systemic antifungal therapy [breakthrough candidaemia (BTC)]. Demographic, clinical, microbiological and molecular features of these episodes were analysed. Compared with 19 patients with de novo candidaemia, patients with BTC were more likely to have neutropenia (81% vs. 63%), longer median duration of neutropenia (27 days vs. 15 days), hypogammaglobulinaemia (62% vs. 37%) and central venous catheters (CVCs) (86% vs. 68%). The median duration of prior antifungal exposure was 46 days (range 3-108 days). Among the 18 available Candida spp. isolates, 15 (83%) were phenotypically susceptible to the antifungal agent that the patient was receiving. Emergence of resistance was the mechanism leading to BTC in three cases of patients receiving echinocandins. Other possible mechanisms of BTC were (i) elevated (≥2) minimum lethal concentration/minimum inhibitory concentration (MLC/MIC) ratio (reduced ability for a fungicidal agent to kill a fungal pathogen) in all patients receiving amphotericin B and (ii) elevated MLC/MIC ratios in all Candida parapsilosis isolates with MICs≤1 μg/mL to echinocandins. DNA sequencing of the hotspot 1 region of the fks1 and fks2 genes in seven different isolates of C. parapsilosis group demonstrated P660A in Fks1 but no polymorphisms in fks2. In conclusion, mechanisms for BTC in the setting of prolonged neutropenia may be host-based (hypogammaglobulinaemia and CVC) and pathogen-based. CLSI interpretive breakpoints do not reliably predict BTC in patients with haematological malignancies and warrant further investigation. Copyright © 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Published
2014

36. A prospective, cohort, multicentre study of candidaemia in hospitalized adult patients with haematological malignancies

Author

Gamaletsou, M.N. Walsh, T.J. Zaoutis, T. Pagoni, M. Kotsopoulou, M. Voulgarelis, M. Panayiotidis, P. Vassilakopoulos, T. Angelopoulou, M.K. Marangos, M. Spyridonidis, A. Kofteridis, D. Pouli, A. Sotiropoulos, D. Matsouka, P. Argyropoulou, A. Perloretzou, S. Leckerman, K. Manaka, A. Oikonomopoulos, P. Daikos, G. Petrikkos, G. Sipsas, N.V.

Abstract

Invasive candidiasis is a life-threatening infection in patients with haematological malignancies. The objective of our study was to determine the incidence, microbiological characteristics and clinical outcome of candidaemia among hospitalized adult patients with haematological malignancies. This is a population-based, prospective, multicentre study of patients ≥18 years admitted to haematology and/or haematopoietic stem cell transplantation units of nine tertiary care Greek hospitals from January 2009 through to February 2012. Within this cohort, we conducted a nested case-control study to determine the risk factors for candidaemia. Stepwise logistic regression was used to identify independent predictors of 28-day mortality. Candidaemia was detected in 40 of 27 864 patients with haematological malignancies vs. 967 of 1 158 018 non-haematology patients for an incidence of 1.4 cases/1000 admissions vs. 0.83/1000 respectively (p

Published
2014

41. Reply to van Leeuwen

Author

Kofteridis, D. P., primary, Georgopoulos, D., additional, Valachis, A., additional, and Samonis, G., additional

Published
2011
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49. Multicentric Castleman's disease

Author

Kofteridis, D P, primary, Tzagarakis, N, additional, Mixaki, I, additional, Maganas, E, additional, Xilouri, E, additional, Stathopoulos, E N, additional, Eliopoulos, G D, additional, and Gikas, A, additional

Published
2004
Full Text
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