Background: Carbapenem resistance in Gram-negative bacteria is associated with severe infections in the hospital setting. No uniform screening policy or agreed set of criteria exists within the EU to inform treatment decisions for infections caused by carbapenem-resistant Gram-negative bacteria. Aim: To develop a range of consensus statements to survey experts in carbapenem resistance, to identify potential similarities and differences across the EU and across specialties. Methods: The survey contained 43 statements, covering six key topics relating to carbapenem-resistant organisms: microbiological screening; diagnosis; infection control implementation; antibiotic stewardship; use of resources; and influencing policy. Findings: In total, 136 survey responses were received (66% infectious disease specialists, 18% microbiologists, 11% intensive care specialists, 4% other/unknown) from France, Germany, Greece, Italy, Spain, and the UK. High, or very high, levels of agreement were seen for all 43 consensus statements, indicating good alignment concerning early identification and optimal management of infection due to carbapenem-resistant organisms. Conclusion: We offer the following recommendations: (1) screening is required when a patient may have been exposed to the healthcare system in countries/hospitals where carbapenem-resistant organisms are endemic; (2) rapid diagnostic tools should be available in every institution; (3) all institutions should have a specific policy for the control of carbapenem-resistant organisms, which is routinely audited; (4) clear strategies are required to define both appropriate and inappropriate use of carbapenems; (5) priority funding should be allocated to the management of infections due to carbapenem-resistant organisms; and (6) international co-operation is required to reduce country-to-country transmission of carbapenem-resistant organisms.
Bibliographical noteFunding Information:
The study was funded by Shionogi . A.P.R.W. was supported, in part, by the National Institute for Health Research at the University College London Hospitals Biomedical Research Centre .
J.-P.B. and A.D. have no relevant disclosures; G.D. has received honoraria from Pfizer, Menarini and MSD, and grants from Pfizer , outside of the submitted work; R.F. has received personal fees from Toray, ThermoFisher, Pfizer, MSD, Becton & Dickinson, Shionogi and Grifols, and a grant from Becton & Dickinson , outside the submitted work; A.P. has received personal fees from Becton & Dickinson and Merck, outside the submitted work; N.P. has been a member of an Advisory Board for Shionogi and has received honoraria for speaker engagements from MSD, Becton & Dickinson, Pfizer, and Cepheid, outside the submitted work; H.S. has received personal fees from Shionogi related to the submitted work, and personal fees from Basilea Pharmaceuticals, Gilead, MSD, Genentech, Entasis, Shionogi, ThermoFisher, bioMérieux, and Becton & Dickinson, and grants from Cubist , Tetraphase , Accelerate , Entasis , and the German Centre for Infection Research (DZIF), outside the submitted work; J.V. has been a member of an Advisory Board for Shionogi outside the submitted work; A.P.R.W. has received research funding from Shionogi , has acted on a Drug Safety Monitoring Board for Roche, and has been a member of an advisory panel for Ideal Standard, outside the submitted work.
© 2020 The Authors
- Antibiotic stewardship
- Carbapenem resistance
- Infection control