Management of bloodstream infections by infection specialists: an international ESCMID cross-sectional survey.
Fiche publication
Date publication
janvier 2018
Journal
International journal of antimicrobial agents
Auteurs
Membres identifiés du Cancéropôle Est :
Pr THILLY Nathalie
Tous les auteurs :
Diallo K, Thilly N, Luc A, Beraud G, Ergonul Ö, Giannella M, Kofteridis D, Kostyanev T, Paňo-Pardo JR, Retamar P, Kern W, Pulcini C,
Lien Pubmed
Résumé
Bloodstream infections (BSIs) are common, however international guidelines are available only for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia and candidaemia. This international ESCMID cross-sectional survey, open from December 2016 to February 2017, explored the management of BSIs by infection specialists. All infection specialists (senior or trainees) giving at least weekly advice on positive blood cultures could participate. Their practices were evaluated using six clinical vignettes presenting uncomplicated BSI cases. A total of 616 professionals from 56 countries participated [333/616 (54%) infectious diseases specialists, 188/616 (31%) clinical microbiologists], of whom 76% (468/616) were members of an antimicrobial stewardship team. Large variations in practice were noted, in particular for the Escherichia coli, Enterococcus faecalis and Pseudomonas aeruginosa vignettes. Echocardiography was considered standard of care by 81% (373/459) of participants for MRSA, 78% (400/510) for methicillin-susceptible S. aureus and 60% (236/395) for Candida albicans. Antimicrobial combination therapy was recommended by 2% (8/360) of respondents for C. albicans, 11% (43/378) for E. coli, 27% (114/420) for MRSA and 39% (155/393) for E. faecalis. Intravenous-to-oral switch was considered in 68% (285/418) for MRSA, 79% (306/388) for E. faecalis, 72% (264/366) for P. aeruginosa and 75% (270/362) for C. albicans. In multivariable analysis, IDSA guideline-compliant practice was more frequent among participants belonging to an antimicrobial stewardship team (aOR = 1.7, P = 0.018 for the MRSA vignette; and aOR = 2.0, P = 0.008 for the candidaemia vignette). This survey showed large variations in practice among infection specialists. International guidelines on management of BSI are urgently needed.
Mots clés
Antibiotic stewardship, Bacteraemia, Blood culture, Candidaemia, Questionnaire, Survey
Référence
Int. J. Antimicrob. Agents. 2018 Jan 5;: