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. 2020 Jan 2;9(1):1.
doi: 10.1186/s13756-019-0662-8. eCollection 2020.

European intensive care physicians' experience of infections due to antibiotic-resistant bacteria

Alain Lepape  1   2   3 , Astrid Jean  1   3 , Jan De Waele  2   4 , Arnaud Friggeri  1   3 , Anne Savey  3 , Philippe Vanhems  3 , Marie Paule Gustin  3 , Dominique L Monnet  5 , José Garnacho-Montero  2   6 , Anke Kohlenberg  5
Affiliations

European intensive care physicians' experience of infections due to antibiotic-resistant bacteria

Alain Lepape et al. Antimicrob Resist Infect Control. .

Abstract

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.

Keywords: Antimicrobial resistance; Antimicrobial treatment; Carbapenem-resistant Enterobacteriaceae; Intensive care; Meticillin-resistant Staphylococcus aureus; Third-generation-cephalosporin-resistant Enterobacteriaceae.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Percentage of ARISE survey participants from the EU/EEA who reported having encountered patients with infections caused by selected antibiotic-resistant bacteria during the past six months prior to the survey (n = number of responses for each bacterium)
Fig. 2
Fig. 2
Percentage of ARISE survey participants from the EU/EEA who reported having encountered at least three patients with infections caused by selected antibiotic-resistant bacteria during the past six months, by European region (n = 858)
Fig. 3
Fig. 3
Percentage of ARISE survey participants from the EU/EEA who reported having used the antibiotics listed in the last-line antibiotics list during the past six months (n = number of responses for each antibiotic)
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