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Fabbri G, Ban G, Pulcini C, Cerutti A, Özcan M. Clinical Performance of Complete-Arch Implant- Supported Rehabilitations Using Monolithic Lithium Disilicate Restorations Bonded to CAD/CAM Titanium and Zirconia Frameworks up to 5 Years. Eur J Prosthodont Restor Dent 2022; 30:296-304. [PMID: 35438262 DOI: 10.1922/ejprd_2069fabbri09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This clinical study evaluated the survival of monolithic lithium disilicate (ML) (IPS Emax, Ivoclar Vivadent) restorations bonded to complete-arch CAD/CAM made titanium or zirconia frameworks. Between August 2007 and December 2009, 15 patients (7 female, 8 male; mean age: 56.8 years old) received 30 implant-supported screw-retained rehabilitations with ML restorations cemented to CAD/CAM made titanium (T) (n=6) or zirconia (Z) frameworks (n=24) adhesively (Multilink Automix, RelyX Unicem) and followed up until December 2015. The evaluation protocol involved technical failures (chipping, debonding or fracture of crown/framework, screw loosening), Californian Dental Association (CDA) quality criteria (Romeo: Excellent; Sierra: Acceptable; Tango: Retrievable; Victor: Not acceptable) and biological failures (mucositis, peri-implantitis). Mean observation time was 60.3 months. No implants were lost, and all the prostheses were in situ. Four mechanical failures occurred in the form of minor chipping (n=3 in ML-Z, n=1 in ML-T) and major fracture in ML crown (n=1 in ML-Z). Romeo scores (N=370) decreased until final observation (N=347) and 23 Sierra scores were given to the restorations. Mucositis was observed in 3 patients and peri-implantitis in one patient. Complete-arch implant-borne FDPs made of monolithic lithium disilicate bonded to titanium or zirconia frameworks could be a promising alternative.
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Affiliation(s)
- G Fabbri
- University of Zurich, Head Division of Dental Biomaterials, Center of Dental Medicine, Clinic of Reconstructive Dentistry, Zurich, Switzerland
- Private Practice, Cattolica, Italy
| | - G Ban
- Private Practice, Cattolica, Italy
| | - C Pulcini
- Private Practice, San Benedetto del Tronto, Italy
| | - A Cerutti
- Professor, University of Brescia, Department of Restorative Dentistry, Brescia, Italy
| | - M Özcan
- University of Zurich, Head Division of Dental Biomaterials, Center of Dental Medicine, Clinic of Reconstructive Dentistry, Zurich, Switzerland
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2
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Patel SV, Pulcini C, Demirjian A, van Hecke O. Rapid diagnostic tests for common infection syndromes: less haste, more speed. J Antimicrob Chemother 2021; 75:2028-2030. [PMID: 32417902 DOI: 10.1093/jac/dkaa164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rapid diagnostic tests, which accurately distinguish bacterial from viral infections, are being heralded as the solution to antibiotic overuse, which is a key driver of antimicrobial resistance. We have concerns that this approach is oversimplistic. Rapid diagnostic tests are complex interventions, with clinical context, patient flow, access and timing affecting their impact. There is little robust evidence that they reduce antibiotic prescribing in real-world settings. We suggest that prior to introducing these costly tests, emphasis should be placed on optimizing the implementation of efficient evidence-based antimicrobial stewardship interventions, such as increasing the use of proven automated clinical infection syndrome prediction tools by clinicians, supporting patients to self-care by providing them with high-quality safety-netting resources, providing front-line clinicians with individual prescribing data to facilitate peer benchmarking and setting specific and purposeful antibiotic prescribing targets to improve the quality of antimicrobial prescribing. The stakes are high and time is running out; let's start by getting the basics right.
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Affiliation(s)
- S V Patel
- Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Pulcini
- Université de Lorraine, EA, 4360 APEMAC, Nancy, France.,CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - A Demirjian
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK.,Faculty of Life Sciences & Medicine, King's College London, London, UK.,Primary Care and Interventions Unit, Healthcare Associated Infections & Antimicrobial Resistance, Public Health England, London, UK
| | - O van Hecke
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
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3
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Krockow EM, Kurvers RHJM, Herzog SM, Kämmer JE, Hamilton RA, Thilly N, Macheda G, Pulcini C. Harnessing the wisdom of crowds can improve guideline compliance of antibiotic prescribers and support antimicrobial stewardship. Sci Rep 2020; 10:18782. [PMID: 33139823 PMCID: PMC7608639 DOI: 10.1038/s41598-020-75063-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/09/2020] [Indexed: 12/26/2022] Open
Abstract
Antibiotic overprescribing is a global challenge contributing to rising levels of antibiotic resistance and mortality. We test a novel approach to antibiotic stewardship. Capitalising on the concept of "wisdom of crowds", which states that a group's collective judgement often outperforms the average individual, we test whether pooling treatment durations recommended by different prescribers can improve antibiotic prescribing. Using international survey data from 787 expert antibiotic prescribers, we run computer simulations to test the performance of the wisdom of crowds by comparing three data aggregation rules across different clinical cases and group sizes. We also identify patterns of prescribing bias in recommendations about antibiotic treatment durations to quantify current levels of overprescribing. Our results suggest that pooling the treatment recommendations (using the median) could improve guideline compliance in groups of three or more prescribers. Implications for antibiotic stewardship and the general improvement of medical decision making are discussed. Clinical applicability is likely to be greatest in the context of hospital ward rounds and larger, multidisciplinary team meetings, where complex patient cases are discussed and existing guidelines provide limited guidance.
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Affiliation(s)
- Eva M Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, LE1 7RH, UK.
| | - R H J M Kurvers
- Center for Adaptive Rationality, Max-Planck Institute for Human Development, Berlin, Germany
| | - S M Herzog
- Center for Adaptive Rationality, Max-Planck Institute for Human Development, Berlin, Germany
| | - J E Kämmer
- Center for Adaptive Rationality, Max-Planck Institute for Human Development, Berlin, Germany
- Department of Emergency Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - R A Hamilton
- School of Pharmacy, De Montfort University, Leicester, UK
| | - N Thilly
- Université de Lorraine, APEMAC, Nancy, France
| | - G Macheda
- Université de Lorraine, APEMAC, Nancy, France
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France
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4
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Thilly N, Pereira O, Schouten J, Hulscher MEJL, Pulcini C. Proxy indicators to estimate the appropriateness of medications prescribed by paediatricians in infectious diseases: a cross-sectional observational study based on reimbursement data. JAC Antimicrob Resist 2020; 2:dlaa086. [PMID: 34223041 PMCID: PMC8209962 DOI: 10.1093/jacamr/dlaa086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/08/2020] [Indexed: 11/14/2022] Open
Abstract
Background We previously developed proxy indicators (PIs) that can be used to estimate the appropriateness of medications used for infectious diseases (in particular antibiotics) in primary care, based on routine reimbursement data that do not include clinical indications. Objectives To: (i) select the PIs that are relevant for children and estimate current appropriateness of medications used for infectious diseases by French paediatricians and its variability while using these PIs; (ii) assess the clinimetric properties of these PIs using a large regional reimbursement database; and (iii) compare performance scores for each PI between paediatricians and GPs in the paediatric population. Methods For all individuals living in north-eastern France, a cross-sectional observational study was performed analysing National Health Insurance data (available at prescriber and patient levels) regarding antibiotics prescribed by their paediatricians in 2017. We measured performance scores of the PIs, and we tested their clinimetric properties, i.e. measurability, applicability and room for improvement. Results We included 116 paediatricians who prescribed a total of 44 146 antibiotic treatments in 2017. For all four selected PIs (seasonal variation of total antibiotic use, amoxicillin/second-line antibiotics ratio, co-prescription of anti-inflammatory drugs and antibiotics), we found large variations between paediatricians. Regarding clinimetric properties, all PIs were measurable and applicable, and showed high improvement potential. Performance scores did not differ between these 116 paediatricians and 3087 GPs. Conclusions This set of four proxy indicators might be used to estimate appropriateness of prescribing in children in an automated way within antibiotic stewardship programmes.
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Affiliation(s)
- N Thilly
- Université de Lorraine, APEMAC, Nancy, France.,Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, Nancy, France
| | - O Pereira
- Direction Régionale du Service Médical Grand Est, Nancy, France
| | - J Schouten
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Department of Intensive Care Medicine, Nijmegen, The Netherlands
| | - M E J L Hulscher
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France.,Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
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Delannoy M, Agrinier N, Charmillon A, Degand N, Dellamonica J, Leone M, Pulcini C, Novy E. Implementation of antibiotic stewardship programmes in French ICUs in 2018: a nationwide cross-sectional survey. J Antimicrob Chemother 2020; 74:2106-2114. [PMID: 30934049 DOI: 10.1093/jac/dkz113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/13/2019] [Accepted: 02/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Antibiotic stewardship programmes have a pivotal role in ICUs, but the level of implementation of these programmes at the regional or national level is not well known. OBJECTIVES The aim of our study was to assess the level of implementation of antibiotic stewardship programmes in French ICUs. METHODS We conducted a nationwide cross-sectional survey from January to March 2018 using an online questionnaire sent as an E-mail link to ICU specialists (one questionnaire per ICU). RESULTS Overall, 113 out of 206 (55%) ICUs participated. Access to local epidemiology regarding bacterial resistance and antibiotic consumption data was reported in 84% and 65% of ICUs, respectively. Local guidelines for antibiotic use were available in 54% of ICUs. The duration of empirical antibiotic therapy was limited in 46% of cases, following the recommendation of an external expert in 33%. An antibiotic stewardship programme leader was reported at the hospital level by 94% of respondents, being an infectious disease physician in 80%. His/her role in the ICU was mostly to discuss specific cases (50%) and to provide advice on antibiotic prescriptions (26%). Regarding microbiological diagnosis, blood cultures were not processed at night or during weekends in 57%. Molecular biology and MS techniques were available in 62% and 59% of cases, respectively. Therapeutic drug monitoring of β-lactams was available in 46% of cases. Forty-three percent of respondents knew the expression 'antimicrobial/antibiotic stewardship'. CONCLUSIONS Antibiotic stewardship programmes are not optimally implemented in French ICUs. Improvement efforts and regular monitoring of the level of implementation are needed.
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Affiliation(s)
- M Delannoy
- Université de Lorraine, CHRU-Nancy, Département d'Anesthésie-Réanimation Brabois, Nancy, France
| | - N Agrinier
- Université de Lorraine, APEMAC, Nancy, France.,CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France
| | - A Charmillon
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - N Degand
- Centre Hospitalier Universitaire de Nice, Hôpital de l'Archet 2, Laboratoire de Bactériologie, Nice, France
| | - J Dellamonica
- Université Nice Cote d'Azur, CHU de Nice, Service de médecine Intensive Réanimation, Archet 1 CS 23079, Nice, France.,INSERM 1065 C3M, Nice, France
| | - M Leone
- Aix Marseille Université, APHM, Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France.,Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - E Novy
- Université de Lorraine, CHRU-Nancy, Département d'Anesthésie-Réanimation Brabois, Nancy, France
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Huttner BD, Catho G, Pano-Pardo JR, Pulcini C, Schouten J. COVID-19: don't neglect antimicrobial stewardship principles! Clin Microbiol Infect 2020; 26:808-810. [PMID: 32360446 PMCID: PMC7190532 DOI: 10.1016/j.cmi.2020.04.024] [Citation(s) in RCA: 213] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 12/27/2022]
Affiliation(s)
- B D Huttner
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - G Catho
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - J R Pano-Pardo
- Division of Infectious Diseases, Hospital Clínico Universitario, IIS Aragón, Zaragoza, Spain
| | - C Pulcini
- Université de Lorraine, APEMAC, équipe MICS, F-54000, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
| | - J Schouten
- Radboud Center for Infectious Diseases; Intensive Care Department, Nijmegen, the Netherlands
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Baudet A, Kichenbrand C, Pulcini C, Descroix V, Lesclous P, Thilly N, Clément C, Guillet J. Antibiotic use and resistance: a nationwide questionnaire survey among French dentists. Eur J Clin Microbiol Infect Dis 2020; 39:1295-1303. [PMID: 32062724 DOI: 10.1007/s10096-020-03849-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/10/2020] [Indexed: 12/17/2022]
Abstract
The aim of this survey was to describe the attitudes and self-reported practices of French dentists towards antibiotic use and resistance and to compare practices with national guidelines. A nationwide cross-sectional internet-based survey was conducted among the 41,800 French dentists. The online questionnaire was distributed through professional networks from April 2017 to April 2018. Seven-hundred seventy-five dentists participated but only 455 questionnaires were complete enough to be included in the analyses. Amoxicillin was the most frequently prescribed antibiotic (65.8%, 1783/2711), followed by spiramycin + metronidazole fixed-dose combination (11.6%, 312/2711) and amoxicillin-clavulanic acid (10.3%, 279/2711). The main indications for use were abscess (349/423, 82.5%), cervicofacial cellulitis (74.2%, 314/423), and pericoronitis (58.6%, 239/408). Most dentists (90.5%, 381/421) considered that antibiotic resistance is of concern but only half of them (56.3%, 238/423) felt adequately informed about antibiotic use. Many dentists did not comply with the national guidelines: the majority of them declared inappropriate antibiotic prescriptions for 11/17 clinical situations. They did not prescribe antibiotics for 5/6 clinical situations requiring prophylaxis. They reported that the publication of clinical guidelines is the main factor influencing their prescriptions (71.0%, 299/421). They wished to receive regular updates of national guidelines in the form of practical sheets (93.0%, 172/185). French dentists should urgently be targeted by antibiotic stewardship initiatives.
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Affiliation(s)
- A Baudet
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France
| | - C Kichenbrand
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France
| | - C Pulcini
- Université de Lorraine, APEMAC, F-54000, Nancy, France
- CHRU-Nancy, Infectious Diseases Department, F-54000, Nancy, France
| | - V Descroix
- Hôpital Pitié-Salpêtrière, Service d'Odontologie, F-75013, Paris, France
| | - P Lesclous
- CHU Nantes, Service d'Odontologie, F-44000, Nantes, France
| | - N Thilly
- Université de Lorraine, APEMAC, F-54000, Nancy, France
- CHRU-Nancy, Département Méthodologie Promotion Investigation, F-54000, Nancy, France
| | - C Clément
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France
| | - J Guillet
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France.
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France.
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Vaillant L, Birgand G, Esposito-Farese M, Astagneau P, Pulcini C, Robert J, Zahar JR, Sales-Wuillemin E, Tubach F, Lucet JC. Awareness among French healthcare workers of the transmission of multidrug resistant organisms: a large cross-sectional survey. Antimicrob Resist Infect Control 2019; 8:173. [PMID: 31749961 PMCID: PMC6852912 DOI: 10.1186/s13756-019-0625-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Much effort has been made over the last two decades to educate and train healthcare professionals working on antimicrobial resistance in French hospitals. However, little has been done in France to assess perceptions, attitudes and knowledge regarding multidrug resistant organisms (MDROs) and, more globally, these have never been evaluated in a large-scale population of medical and non-medical healthcare workers (HCWs). Our aim was to explore awareness among HCWs by evaluating their knowledge of MDROs and the associated control measures, by comparing perceptions between professional categories and by studying the impact of training and health beliefs. Methods A multicentre cross-sectional study was conducted in 58 randomly selected French healthcare facilities with questionnaires including professional and demographic characteristics, and knowledge and perception of MDRO transmission and control. A knowledge score was calculated and used in a logistic regression analysis to identify factors associated with higher knowledge of MDROs, and the association between knowledge and perception. Results Between June 2014 and March 2016, 8716/11,753 (participation rate, 74%) questionnaires were completed. The mean knowledge score was 4.7/8 (SD: 1.3) and 3.6/8 (SD: 1.4) in medical and non-medical HCWs, respectively. Five variables were positively associated with higher knowledge: working in a university hospital (adjusted odds ratio, 1.41, 95% CI 1.16–1.70); age classes 26–35 years (1.43, 1.23–1.6) and 36–45 years (1.19, 1.01–1.40); medical professional status (3.7, 3.09–4.44), working in an intensive care unit (1.28, 1.06–1.55), and having been trained on control of antimicrobial resistance (1.31, 1.16–1.48). After adjustment for these variables, greater knowledge was significantly associated with four cognitive factors: perceived susceptibility, attitude toward hand hygiene, self-efficacy, and motivation. Conclusions We found a low level of MDRO awareness and knowledge of associated control measures among French HCWs. Training on hand hygiene and measures to control MDRO spread may be helpful in shaping beliefs and perceptions on MDRO control among other possible associated factors. Messages should be tailored to professional status and their perception. Other approaches should be designed, with more effective methods of training and cognitive interventions. Trial registration Clinical Trials.gov NCT02265471. Registered 16 October 2014 - Retrospectively registered.
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Affiliation(s)
- L Vaillant
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, 48 rue Henri Huchard, F-75018 Paris, France
| | - G Birgand
- 2Department of Medicine, NIHR, Imperial College London, Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection Imperial College London, South Kensington Campus, London, SW7 2AZ UK
| | - M Esposito-Farese
- AP-HP, Bichat-Claude Bernard Hospital, Unité de Recherche Clinique Paris Nord Val de Seine and CIC-EC 1425, 48 rue Henri Huchard, F-75018 Paris, France
| | - P Astagneau
- 4Medecine Sorbonne University, AP-HP, Regional centre for Prevention of Healthcare-associated infections, 8 rue Maria Helena Vieira da Silva, 75014 Paris, France
| | - C Pulcini
- 5EA 4360 APEMAC, CHRU de Nancy, University of Lorraine, Infectious and Tropical Diseases Unit, 34 Cours Léopold, 54000 Nancy, France
| | - J Robert
- Sorbonne University, U1135, Team E13, CR7 INSERM, AP-HP, Pitié-Salpêtrière Hospital, Bactériologie-Hygiène, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - J R Zahar
- 7AP-HP, Avicenne Hospital, Infection Control Unit, 125 Rue de Stalingrad, 93000 Bobigny, France.,8University of Paris, INSERM, IAME, UMR 1137, Paris, France
| | | | - F Tubach
- INSERM, UMR 1123, AP-HP, Pitié-Salpêtrière Hospital, Centre de Pharmacoépidémiologie (Cephepi), 75013 Paris, France
| | - J C Lucet
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, 48 rue Henri Huchard, F-75018 Paris, France.,8University of Paris, INSERM, IAME, UMR 1137, Paris, France
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9
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Schweitzer VA, van Werkhoven CH, Rodríguez Baño J, Bielicki J, Harbarth S, Hulscher M, Huttner B, Islam J, Little P, Pulcini C, Savoldi A, Tacconelli E, Timsit JF, van Smeden M, Wolkewitz M, Bonten MJM, Walker AS, Llewelyn MJ. Optimizing design of research to evaluate antibiotic stewardship interventions: consensus recommendations of a multinational working group. Clin Microbiol Infect 2019; 26:41-50. [PMID: 31493472 DOI: 10.1016/j.cmi.2019.08.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Antimicrobial stewardship interventions and programmes aim to ensure effective treatment while minimizing antimicrobial-associated harms including resistance. Practice in this vital area is undermined by the poor quality of research addressing both what specific antimicrobial use interventions are effective and how antimicrobial use improvement strategies can be implemented into practice. In 2016 we established a working party to identify the key design features that limit translation of existing research into practice and then to make recommendations for how future studies in this field should be optimally designed. The first part of this work has been published as a systematic review. Here we present the working group's final recommendations. METHODS An international working group for design of antimicrobial stewardship intervention evaluations was convened in response to the fourth call for leading expert network proposals by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). The group comprised clinical and academic specialists in antimicrobial stewardship and clinical trial design from six European countries. Group members completed a structured questionnaire to establish the scope of work and key issues to develop ahead of a first face-to-face meeting that (a) identified the need for a comprehensive systematic review of study designs in the literature and (b) prioritized key areas where research design considerations restrict translation of findings into practice. The working group's initial outputs were reviewed by independent advisors and additional expertise was sought in specific clinical areas. At a second face-to-face meeting the working group developed a theoretical framework and specific recommendations to support optimal study design. These were finalized by the working group co-ordinators and agreed by all working group members. RESULTS We propose a theoretical framework in which consideration of the intervention rationale the intervention setting, intervention features and the intervention aims inform selection and prioritization of outcome measures, whether the research sets out to determine superiority or non-inferiority of the intervention measured by its primary outcome(s), the most appropriate study design (e.g. experimental or quasi- experimental) and the detailed design features. We make 18 specific recommendation in three domains: outcomes, objectives and study design. CONCLUSIONS Researchers, funders and practitioners will be able to draw on our recommendations to most efficiently evaluate antimicrobial stewardship interventions.
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Affiliation(s)
- V A Schweitzer
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| | - C H van Werkhoven
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands
| | - J Rodríguez Baño
- Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Department of Medicine, Hospital Universitario Virgen Macarena, Universidad de Sevilla and Biomedicine Institute of Sevilla (IBiS), Seville, Spain
| | - J Bielicki
- Paediatric Infectious Disease Research Group, St George's University of London, London, UK
| | - S Harbarth
- Department of Infectious Diseases and Infection Control, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - M Hulscher
- Scientific Centre for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - B Huttner
- Department of Infectious Diseases and Infection Control, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - J Islam
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer, UK
| | - P Little
- Department of Primary Care Research, University of Southampton, Southampton, UK
| | - C Pulcini
- Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, APEMAC, Université de Lorraine, Nancy, France
| | - A Savoldi
- Infectious Diseases, Department of Diagnostic and Public Health, Verona, Italy; University Hospital, Internal Medicine, Tuebingen University, Germany
| | - E Tacconelli
- Infectious Diseases, Department of Diagnostic and Public Health, Verona, Italy; University Hospital, Internal Medicine, Tuebingen University, Germany
| | - J-F Timsit
- Medical and Infectious Diseases ICU, Bichat University Hospital, AP-HP, Paris, France; UMR 1137, Infection Antimicrobials Modelling Evolution, Paris Diderot University, Paris, France
| | - M van Smeden
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M Wolkewitz
- Institute for Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - M J M Bonten
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - A S Walker
- MRC Clinical Trials Unit, University College London, London, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - M J Llewelyn
- Department of Primary Care Research, University of Southampton, Southampton, UK.
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10
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Affiliation(s)
- C Pulcini
- Université de Lorraine, APEMAC, équipe MICS, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France.
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Corbel A, Ladrière M, Le Berre N, Durin L, Rousseau H, Frimat L, Thilly N, Pulcini C. Microbiological epidemiology of preservation fluids in transplanted kidney: a nationwide retrospective observational study. Clin Microbiol Infect 2019; 26:475-484. [PMID: 31382016 DOI: 10.1016/j.cmi.2019.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Kidney transplant recipients are at high-risk for donor-derived infections in the early post-transplant period. Transplant preservation fluid (PF) samples are collected for microbiological analysis. In case of positive PF cultures, the risk for the recipient is unknown and there is no consensus for prescribing prophylactic antibiotics. This nationwide observational study aimed to determine the epidemiology of bacterial and fungal agents in kidney transplant PF cultures and identify risk factors associated with positive PF cultures. METHODS We performed a retrospective observational study on the following data collected from a national database between October 2015 and December 2016: characteristics of donor, recipient, transplantation, infection in donor and PF microbiological data. RESULTS Of 4487 kidney transplant procedures, including 725 (16.2%, 725/4487) from living donors, 20.5% had positive PF cultures (living donors: 1.8%, 13/725; deceased donors: 24.1%, 907/3762). Polymicrobial contamination was found in 59.9% (485/810) of positive PF cultures. Coagulase-negative staphylococci (65.8%, 533/810) and Enterobacteriaceae (28.0%, 227/810) were the most common microorganisms. Factors associated with an increased risk of positive PF cultures in multivariable analysis were (for deceased-donor kidney transplants): intestinal perforation during procurement (OR 4.4, 95% CI 2.1-9.1), multiorgan procurement (OR 1.4, 95% CI 1.1-1.7) and en bloc transplantation (OR 2.5, 95% CI 1.3-4.9). Use of perfusion pump and donor antibiotic therapy were associated with a lower risk of positive PF cultures (OR 0.4, 95% CI 0.3-0.5 and OR 0.6, 95% CI 0.5-0.7, respectively). CONCLUSION In conclusion, 24% of deceased-donor PF cultures were positive, and PF contamination during procurement seemed to be the major cause.
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Affiliation(s)
- A Corbel
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France.
| | - M Ladrière
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France
| | - N Le Berre
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France
| | - L Durin
- Agence de la Biomédecine, Saint Denis La Plaine, France
| | - H Rousseau
- Plateforme d'Aide à la Recherche Clinique, University of Lorraine, CHRU-Nancy, Nancy, France
| | - L Frimat
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France; APEMAC, University of Lorraine, Nancy, France
| | - N Thilly
- Plateforme d'Aide à la Recherche Clinique, University of Lorraine, CHRU-Nancy, Nancy, France; APEMAC, University of Lorraine, Nancy, France
| | - C Pulcini
- APEMAC, University of Lorraine, Nancy, France; Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, Nancy, France
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Leone M, Pulcini C, De Waele J. Improving care for the ICU patient with suspected infection: a multidisciplinary perspective. Clin Microbiol Infect 2019; 26:6-7. [PMID: 31357011 DOI: 10.1016/j.cmi.2019.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/18/2019] [Indexed: 12/28/2022]
Affiliation(s)
- M Leone
- Aix Marseille Université, Assistance Publique-Hôpitaux de Marseille, Service d'Anesthésie et de Réanimation, Hôpital Nord, Marseille, France; MEPHI, IHU Méditerranée Infection, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, IHU Méditerranée Infection, Marseille, France.
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
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Macheda G, Luc A, Béraud G, Castan B, Gauzit R, Lesprit P, Tattevin P, Thilly N, Pulcini C. Impact of the French Infectious Diseases Society's (SPILF) proposals for shorter antibiotic therapies. Med Mal Infect 2019; 49:456-462. [PMID: 31351803 DOI: 10.1016/j.medmal.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/31/2018] [Accepted: 07/03/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare the practices of French infection specialists related to antibiotic therapy duration between 2016 and 2018. METHODS We conducted two identical surveys (in 2016 and 2018) targeting hospital-based infection specialists (medical physicians, pharmacists) who gave at least weekly advice on antibiotic prescriptions. The questionnaire included 15 clinical vignettes. Part A asked about the durations of antibiotic therapies they would usually advise to prescribers, and part B asked about the shortest duration they would be willing to advise for the same clinical situations. RESULTS We included 325 specialists (165 in 2016 and 160 in 2018), mostly infectious disease specialists (82.4%, 268/325), members of antibiotic stewardship teams in 72% (234/325) of cases. Shorter antibiotic treatments (as compared with the literature) were advised to prescribers in more than half of the vignettes by 71% (105/147) of respondents in 2018, versus 46% (69/150) in 2016 (P<0.001). Guidelines used by participants displayed fixed durations for 77% (123/160) of cases in 2018 versus 21% (35/165) in 2016. Almost all respondents (89%, 131/160) declared they were aware of the 2017 SPILF's proposal. CONCLUSION The release of guidelines promoting shorter durations of antibiotic therapy seems to have had a favourable impact on practices of specialists giving advice on antibiotic prescriptions.
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Affiliation(s)
- G Macheda
- Infectious diseases department, université de Lorraine, CHRU de Nancy, 54000 Nancy, France
| | - A Luc
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, 54000 Nancy, France
| | - G Béraud
- Médecine interne et maladies infectieuses, CHU de Poitiers, 86021 Poitiers, France; Centre de recherche du CHU de Québec, université Laval, hôpital Saint-Sacrement, chemin Sainte-Foy, Québec, Canada; Hasselt university, interuniversity institute for biostatistics and statistical bioinformatics, Censtat, Hasselt, Belgium
| | - B Castan
- Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, 20303 Ajaccio, France
| | - R Gauzit
- Équipe mobile d'infectiologie, université Paris Descartes, hôpitaux universitaires Paris centre-site Cochin, AP-HP, 75014 Paris, France
| | - P Lesprit
- Hôpital Foch, 92151 Suresnes, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU de Rennes, 35033 Rennes, France
| | - N Thilly
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, 54000 Nancy, France; Université de Lorraine, APEMAC, 54000 Nancy, France
| | - C Pulcini
- Infectious diseases department, université de Lorraine, CHRU de Nancy, 54000 Nancy, France; Université de Lorraine, APEMAC, 54000 Nancy, France.
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Kallen MC, Binda F, Ten Oever J, Tebano G, Pulcini C, Murri R, Beovic B, Saje A, Prins JM, Hulscher MEJL, Schouten JA. Comparison of antimicrobial stewardship programmes in acute-care hospitals in four European countries: A cross-sectional survey. Int J Antimicrob Agents 2019; 54:338-345. [PMID: 31200022 DOI: 10.1016/j.ijantimicag.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/20/2019] [Accepted: 06/02/2019] [Indexed: 12/17/2022]
Abstract
Antimicrobial stewardship programmes (ASPs) are designed to improve antibiotic use. A survey was systematically developed to assess ASP prerequisites, objectives and improvement strategies in hospitals. This study assessed the current state of ASPs in acute-care hospitals throughout Europe. A survey containing 46 questions was disseminated to acute-care hospitals: all Dutch (n = 80) and Slovenian (n = 29), 215 French (25%, random stratified sampling) and 62 Italian (49% of hospitals with an infectious diseases department, convenience sampling) acute-care hospitals, for a Europe-wide assessment. Response rates for the Netherlands (Nl), Slovenia (Slo), France (Fr) and Italy (It) were 80%, 86%, 45% and 66%. There was variation between countries in the prerequisites met and the objectives and improvement strategies chosen. A formal ASP was present mainly in the Netherlands (90%) and France (84%) compared with Slovenia (60%) and Italy (60%). Presence of an antimicrobial stewardship (AMS) team ranged from 42% (Fr) to 94% (Nl). Salary support for AMS teams was provided in 68% (Fr), 51% (Nl), 33% (Slo) and 12% (It) of surveyed hospitals. Quantity of antibiotic use was monitored in the majority of hospitals, ranging from 72% (Nl) to 100% (Slo and Fr) of acute-care hospitals. Participating countries varied substantially in the use of 'prospective monitoring and advice' as a strategy to improve AMS objectives. ASP prerequisites, objectives and improvement activities vary considerably across Europe, with room for improvement. Stimulating appropriate system prerequisites throughout Europe, e.g. by introducing staffing standards and financial support for ASPs, seems a first priority.
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Affiliation(s)
- M C Kallen
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands.
| | - F Binda
- Université de Lorraine, APEMAC, Nancy, France; University of Milan, Department of Biomedical and Clinical Sciences 'Luigi Sacco', Milan, Italy
| | - J Ten Oever
- Radboud University Medical Center, Department of Internal Medicine, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - G Tebano
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, AP-PH, Paris, France; Sorbonne University, UPMC Univ. Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - R Murri
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - B Beovic
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - A Saje
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - J M Prins
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands
| | - M E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - J A Schouten
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein Zuid 10, Nijmegen, the Netherlands; Radboud University Medical Center, Department of Intensive Care Medicine, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands.
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Delannoy M, Agrinier N, Charmillon A, Dellamonica J, Degand N, Leone M, Pulcini C, Novy E. Application de programmes de bon usage des antibiotiques dans les services de réanimation français en 2018 : enquête nationale multicentrique. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Abdo F, Marin E, Meyer F, Rabaud C, Pulcini C, May T, Demore B, Goehringer F. Pertinence de l’usage de la daptomycine dans un centre hospitalier universitaire : étude rétrospective monocentrique. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Egrot C, Dinh A, Amarenco G, Bernard L, Birgand G, Bruyère F, Chartier-Kastler E, Cosson M, Deffieux X, Denys P, Etienne M, Fatton B, Fritel X, Gamé X, Lawrence C, Lenormand L, Lepelletier D, Lucet JC, Marit Ducamp E, Pulcini C, Robain G, Senneville E, de Sèze M, Sotto A, Zahar JR, Caron F, Hermieu JF. [Antibiotic prophylaxis in urodynamics: Clinical practice guidelines using a formal consensus method]. Prog Urol 2018; 28:943-952. [PMID: 30501940 DOI: 10.1016/j.purol.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS). MATERIALS AND METHODS Clinical practice guidelines were provided using a formal consensus method. Guidelines proposals were drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12 experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group). RESULTS Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age > 70 years, recurrent UTI, and post-void residual volume > 100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure > 40cmH2O. If the urine culture is negative before UDS and there is no risk factor for UTI, antibiotic prophylaxis is not recommended (Strong agreement). If the urine culture is negative before UDS, but there are one or more risk factors for UTI, antibiotic prophylaxis is optional. If antibiotic prophylaxis is initiated, a single oral dose (3g) of fosfomycin-tromethamine two hours before UDS is recommended (Strong agreement). If there is bacterial colonization on UCB before UDS, antibiotic therapy is optional (Undecided). If prescribed, it should be adapted to the antimicrobial susceptibility of the identified bacterium or bacteria, started the day before and stopped after UDS (except for fosfomycin-tromethamine: a single dose the day before UDS is necessary and sufficient) (Strong agreement). In the event of UTI before UDS, the UTI should be treated and UDS postponed (Strong agreement). The proposed recommendations should not be changed for patients with a hip or knee replacement (Strong agreement). No antibiotic prophylaxis of bacterial endocarditis is necessary, including in high-risk patients with valvular heart disease (Strong agreement). CONCLUSION These new guidelines should help to harmonize clinical practice and limit exposure to antibiotics. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- C Egrot
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - A Dinh
- Unité de maladies infectieuses, UVSQ, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - G Amarenco
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - L Bernard
- Service de médecine interne et maladies infectieuses, centre hospitalier régional Bretonneau, 37000 Tours, France
| | - G Birgand
- Centre de prévention des infections associées aux soins, CHU de Nantes, 5, rue du Pr-Boquien, 44000 Nantes, France
| | - F Bruyère
- Service d'urologie, centre hospitalier régional universitaire de Tours, 37000 Tours, France
| | - E Chartier-Kastler
- Médecine Sorbonne Université, hôpital universitaire de la Pitié-Salpêtrière, 75013 Paris, France
| | - M Cosson
- Laboratoire BioTIM, école centrale de Lille, université de Lille, CHU de Lille, 59000 Lille, France
| | - X Deffieux
- Service de gynécologie obstétrique, université Paris-Sud, hôpital Antoine-Béclère, groupe hospitalier Sud, AP-HP, 92140 Clamart, France
| | - P Denys
- Service de neuro-urologie, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - M Etienne
- Service de maladies infectieuses et tropicales, hôpital Charles-Nicolle, CHU de Rouen, 76000 Rouen, France
| | - B Fatton
- Unité d'urogynécologie, groupe hospitalier Carémeau, CHU de Nîmes, 30029 Nîmes, France
| | - X Fritel
- Service de gynécologie-obstétrique, CHU de Poitiers, 86000 Poitiers, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - C Lawrence
- Service microbiologie et hygiène, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - L Lenormand
- Service d'urologie, centre fédératif de pelvipérinéologie, CHU de Nantes, place A.-Ricordeau, 44093 Nantes cedex 01, France
| | - D Lepelletier
- Service bactériologie et hygiène hospitalière, CHU de Nantes, 44093 Nantes cedex 01, France
| | - J-C Lucet
- Service de bactériologie, hygiène, virologie, parasitologie, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | - E Marit Ducamp
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - C Pulcini
- Infectious Diseases Department, université de Lorraine, APEMAC, CHRU de Nancy, 54000 Nancy, France
| | - G Robain
- Service de rééducation neurologique, hôpital Rothschild, AP-HP, 75012 Paris, France
| | - E Senneville
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier Gustave-Dron, CHRU de Lille, 59200 Tourcoing, France
| | - M de Sèze
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - A Sotto
- Service des maladies infectieuses et tropicales, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex, France
| | - J-R Zahar
- Département de microbiologie, hôpital Avicenne, AP-HP, groupe hospitalier Paris-Seine-Saint-Denis, 93000 Bobigny, France; Unité de recherche Inserm 1137, IAME, université Paris-13, 93000 Bobigny, France
| | - F Caron
- Service des maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Rouen, CHU de Rouen, 76000 Rouen, France
| | - J-F Hermieu
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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Dyar OJ, Beović B, Pulcini C, Tacconelli E, Hulscher M, Cookson B. ESCMID generic competencies in antimicrobial prescribing and stewardship: towards a European consensus. Clin Microbiol Infect 2018; 25:13-19. [PMID: 30414817 DOI: 10.1016/j.cmi.2018.09.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/14/2018] [Accepted: 09/23/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop a consensus-based set of generic competencies in antimicrobial prescribing and stewardship for European prescribers through a structured consensus procedure. METHODS The RAND-modified Delphi procedure comprised two online questionnaire rounds, a face-to-face meeting between rounds, and a final review. Our departure point was a set of competencies agreed previously by consensus among a UK multi-disciplinary panel, and which had been subsequently revised through consultation with ESCMID Study Group representatives. The 46 draft competency points were reviewed by an expert panel consisting of specialists in infectious diseases and clinical microbiology, and pharmacists. Each proposed competency was assessed using a nine-point Likert scale, for relevance as a minimum standard for all independent prescribers in all European countries. RESULTS A total of 65 expert panel members participated, from 24 European countries (one to six experts per country). There was very high satisfaction (98%) with the final competencies set, which included 35 competency points, in three sections: core concepts in microbiology, pathogenesis and diagnosing infections (11 points); antimicrobial prescribing (20 points); and antimicrobial stewardship (4 points). CONCLUSIONS The consensus achieved enabled the production of generic antimicrobial prescribing and stewardship competencies for all European independent prescribers, and of possible global utility. These can be used for training and can be further adapted to the needs of specific professional groups.
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Affiliation(s)
- O J Dyar
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - B Beović
- University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - E Tacconelli
- Division of Infectious Diseases, Department of Diagnostic and Public Health, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - M Hulscher
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - B Cookson
- Division of Infection and Immunity, University College London, London, UK
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Lévin C, Thilly N, Dousak M, Beraud G, Klesnik M, Uhan S, Nathwani D, Beovic B, Pulcini C. Perceptions, attitudes, and practices of French junior physicians regarding antibiotic use and resistance. Med Mal Infect 2018; 49:241-249. [PMID: 30266431 DOI: 10.1016/j.medmal.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 12/08/2017] [Accepted: 09/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the perceptions, attitudes, and practices of French junior physicians regarding antibiotic use and resistance, and then to identify the characteristics of junior physicians associated with appropriate practices of antibiotic use. METHOD European junior physicians received an email invitation to complete a 49 item web questionnaire between September 2015 and January 2016. We present the French data. Multivariate regression models were used to identify the characteristics of junior physicians associated with appropriate prescription practices and with consideration of the antibiotic prescription consequences. RESULTS The questionnaire was completed by 641 junior physicians: family medicine (37%), other medical specialties (e.g., pediatrics, internal medicine, neurology: 45%), surgical specialties (11%), and anesthesiology-intensive care specialty (7%). Most respondents (93%) declared being aware of the risk of bacterial resistance and 41% acknowledged prescribing antibiotics more often than necessary. Two factors were independently associated with appropriate prescription practices: a high perceived level of education on antibiotic use (OR=1.51; 95% CI [1.01-2.30]) and a medical specialty (OR=1.69; 95% CI [1.16-2.46]). Factors independently associated with taking into account adverse events of antibiotics were a good perceived knowledge of antibiotics (OR=3.71; 95% CI [2.09-6.61]), and a high perceived education level on antibiotics (OR=1.70; 95% CI [1.11-2.58]). CONCLUSION Our data can help better define interventions targeting junior physicians in antibiotic stewardship programs.
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Affiliation(s)
- C Lévin
- EA 4360 APEMAC, faculté de médecine de Nancy, université de Lorraine, 9, avenue de la Fôret-de-Haye, BP 20199, 54505 Nancy, France.
| | - N Thilly
- EA 4360 APEMAC, faculté de médecine de Nancy, université de Lorraine, 9, avenue de la Fôret-de-Haye, BP 20199, 54505 Nancy, France; Centre hospitalier universitaire de Nancy, plateforme d'aide à la recherche clinique, 54000 Nancy, France
| | - M Dousak
- Faculty of Social Sciences, University of Ljubljana, Slovenia
| | - G Beraud
- Santé des populations et pratiques optimales en santé, centre de recherche du CHU de Québec-Université Laval, hôpital Saint-Sacrement, Québec, Canada; Service de médecine interne et maladies infectieuses, centre hospitalier universitaire de Poitiers, 86021 Poitiers, France; Censtat, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgique
| | - M Klesnik
- Department of Infectious Disease, University Medical Centre, Ljubljana, Slovenia
| | - S Uhan
- Faculty of Social Sciences, University of Ljubljana, Slovenia
| | - D Nathwani
- Infection Unit, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - B Beovic
- Department of Infectious Disease, University Medical Centre, Ljubljana, Slovenia
| | - C Pulcini
- EA 4360 APEMAC, faculté de médecine de Nancy, université de Lorraine, 9, avenue de la Fôret-de-Haye, BP 20199, 54505 Nancy, France; Service de maladies infectieuses et tropicales, université de Lorraine, CHRU de Nancy, 54000 Nancy, France
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Pulcini C, Binda F, Sankhil Lamkang A, Trett A, Gandra S, Laxminarayan R. Mesures essentielles aux programmes de bon usage des antibiotiques au niveau international. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- A Huttner
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Clinical Microbiology and Infection Editorial Board, Israel.
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France; Clinical Microbiology and Infection Editorial Board, Israel
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Zanichelli V, Tebano G, Gyssens IC, Vlahović-Palčevski V, Monnier AA, Stanic Benic M, Harbarth S, Hulscher M, Pulcini C, Huttner BD. Patient-related determinants of antibiotic use: a systematic review. Clin Microbiol Infect 2018; 25:48-53. [PMID: 29777927 DOI: 10.1016/j.cmi.2018.04.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/17/2018] [Accepted: 04/28/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES We aimed to assess patient-related determinants potentially influencing antibiotic use. METHODS Studies published in MEDLINE until 30 September 2015 were searched. We included: qualitative studies describing patients' self-reported determinants of antibiotic use; and quantitative studies on either self-reported or objectively assessed determinants associated with antibiotic use. Whenever possible, reported determinants were categorized as 'barriers' or 'facilitators' of responsible antibiotic use. RESULTS A total of 87 studies from 33 countries were included. Seventy-five (86.2%) were quantitative and described self-reported (45/75, 60.0%), objectively assessed (20/75, 26.7%) or self-reported and objectively assessed (10/75, 13.3%) patient-related determinants. Twelve (12/87, 13.8%) were qualitative studies or had a qualitative and quantitative component. Eighty-six of the studies (98.8%) concerned the outpatient setting. We identified seven broad categories of determinants having an impact on different aspects of antibiotic use (in descending order of frequency): demographic and socio-economic characteristics, patient-doctor interactions (e.g. counselling), treatment characteristics (e.g. administration frequency), attitudes (e.g. expecting antibiotics), access to treatment (e.g. patients' direct costs), characteristics of the condition for which the antibiotic was prescribed (e.g. duration of symptoms), knowledge (e.g. regarding indications for treatment). Most determinants were classified as 'barriers' to responsible antibiotic use. CONCLUSION A large variety of patient-related determinants impact antibiotic use. The most easily 'modifiable' determinants concern patient-doctor interactions, treatment characteristics and knowledge. Data from the inpatient setting and low- and middle-income countries were underrepresented. Further studies should develop and test interventions that take these determinants into account with the ultimate aim of improving responsible use of antibiotics.
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Affiliation(s)
- V Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - G Tebano
- Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - I C Gyssens
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - V Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia; University of Rijeka, Medical Faculty, Rijeka, Croatia
| | - A A Monnier
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium; Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Stanic Benic
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
| | - S Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - M Hulscher
- Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Pulcini
- Université de Lorraine, EA 4360 APEMAC, Nancy, France; CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - B D Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Zanichelli V, Monnier AA, Tebano G, Stanić BM, Gyssens IC, Pulcini C, Vlahović-Palčevski V, Schindler M, Harbarth S, Hulscher M, Huttner BD. Views and experiences with regard to antibiotic use of hospitalized patients in five European countries: a qualitative descriptive study. Clin Microbiol Infect 2018; 25:249.e7-249.e12. [PMID: 29777924 DOI: 10.1016/j.cmi.2018.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/17/2018] [Accepted: 04/28/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore inpatients experiences and views with regard to antibiotics in five European hospitals. METHODS Qualitative study where a patient-centred framework was used to explore inpatients' experiences concerning antibiotic treatment. A purposeful sample of inpatients treated with antibiotics in five hospitals participated in interviews (all centres) and focus groups (Switzerland only). RESULTS A total of 31 interviews (five in Belgium, ten in Croatia, nine in France, five in the Netherlands and two in Switzerland) and three focus groups (in Switzerland, 11 participants) were performed. The median age of participants was 61 years (range 33-86 years). The following main themes emerged: (a) patients trust doctors to take the best decisions for them even though communication concerning different antibiotic-related aspects is often insufficient, (b) patients feel that doctors do not prioritize communication due to time constraints and do not seem to adapt information based on patients' preferences, (c) patients differ in their wish to be informed but overall want to be informed on the main aspects in an understandable way, (d) patients often find reassurance in sharing information about their antibiotic treatment with close family, (e) professionals should explore patients' preferences to be involved or not in shared decision making for antibiotic treatment. CONCLUSION Inpatients often doubt their ability to understand medical information and trust their physicians to take the best decisions for them. Tailored strategies that inform hospitalized patients, acknowledging their concerns and preferences, may be useful to promote patient involvement and to improve communication regarding antibiotic use.
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Affiliation(s)
- V Zanichelli
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - A A Monnier
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands; Scientific Centre for Quality of Healthcare, IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - G Tebano
- Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - B M Stanić
- Department of Clinical Pharmacology, University Hospital Rijeka, Croatia
| | - I C Gyssens
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - C Pulcini
- Université de Lorraine, EA 4360 APEMAC, Nancy, France; CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - V Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka, Croatia; University of Rijeka, Medical Faculty, Rijeka, Croatia
| | - M Schindler
- Sociology Department, University of Geneva, Geneva, Switzerland
| | - S Harbarth
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - M Hulscher
- Scientific Centre for Quality of Healthcare, IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - B D Huttner
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Pulcini C, Beovic B, Howard P, Mendelson M. Human resources estimates and funding for antibiotic stewardship teams are urgently needed: authors' response. Clin Microbiol Infect 2018; 24:557. [DOI: 10.1016/j.cmi.2018.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/13/2018] [Indexed: 01/28/2023]
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25
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Pulcini C, Binda F, Lamkang AS, Trett A, Charani E, Goff DA, Harbarth S, Hinrichsen SL, Levy-Hara G, Mendelson M, Nathwani D, Gunturu R, Singh S, Srinivasan A, Thamlikitkul V, Thursky K, Vlieghe E, Wertheim H, Zeng M, Gandra S, Laxminarayan R. Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach. Clin Microbiol Infect 2018; 25:20-25. [PMID: 29625170 DOI: 10.1016/j.cmi.2018.03.033] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/18/2018] [Accepted: 03/22/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES With increasing global interest in hospital antimicrobial stewardship (AMS) programmes, there is a strong demand for core elements of AMS to be clearly defined on the basis of principles of effectiveness and affordability. To date, efforts to identify such core elements have been limited to Europe, Australia, and North America. The aim of this study was to develop a set of core elements and their related checklist items for AMS programmes that should be present in all hospitals worldwide, regardless of resource availability. METHODS A literature review was performed by searching Medline and relevant websites to retrieve a list of core elements and items that could have global relevance. These core elements and items were evaluated by an international group of AMS experts using a structured modified Delphi consensus procedure, using two-phased online in-depth questionnaires. RESULTS The literature review identified seven core elements and their related 29 checklist items from 48 references. Fifteen experts from 13 countries in six continents participated in the consensus procedure. Ultimately, all seven core elements were retained, as well as 28 of the initial checklist items plus one that was newly suggested, all with ≥80% agreement; 20 elements and items were rephrased. CONCLUSIONS This consensus on core elements for hospital AMS programmes is relevant to both high- and low-to-middle-income countries and could facilitate the development of national AMS stewardship guidelines and adoption by healthcare settings worldwide.
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Affiliation(s)
- C Pulcini
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France.
| | - F Binda
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France; University of Milan, Department of Biomedical and Clinical Sciences «Luigi Sacco», Milan, Italy
| | - A S Lamkang
- Center for Disease Dynamics, Economics & Policy (CDDEP), New Delhi, India
| | - A Trett
- Center for Disease Dynamics, Economics & Policy (CDDEP), New Delhi, India
| | - E Charani
- Imperial College London, Department of Medicine, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, London, UK
| | - D A Goff
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - S Harbarth
- Geneva University Hospitals, Infection Control Program and WHO Collaborating Center, Faculty of Medicine, Geneva, Switzerland
| | - S L Hinrichsen
- Universidade Federal de Pernambuco (UFPE), Tropical Diseases Department, Recife, Brazil
| | - G Levy-Hara
- Hospital Carlos G Durand, Unit of Infectious Diseases, Buenos Aires, Argentina
| | - M Mendelson
- Groote Schuur Hospital, University of Cape Town, Department of Medicine, Division of Infectious Diseases & HIV Medicine, Cape Town, South Africa
| | - D Nathwani
- Ninewells Hospital and Medical School, Dundee, UK
| | - R Gunturu
- The Aga Khan University Hospital, Dept. of Pathology, Division of Clinical Microbiology, Nairobi, Kenya
| | - S Singh
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - A Srinivasan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - V Thamlikitkul
- Mahidol University, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - K Thursky
- National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute, Melbourne, Australia
| | - E Vlieghe
- University Hospital Antwerp, Department of General Internal Medicine, Infectious Diseases & Tropical Medicine, Antwerp, Belgium; University of Antwerp, Global Health Institute, Antwerp, Belgium; Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
| | - H Wertheim
- Radboudumc, Department of Medical Microbiology and Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
| | - M Zeng
- Children's Hospital of Fudan University, Department of Infectious Diseases, Shanghai, China
| | - S Gandra
- Center for Disease Dynamics, Economics & Policy (CDDEP), New Delhi, India
| | - R Laxminarayan
- Center for Disease Dynamics, Economics & Policy (CDDEP), New Delhi, India; Princeton University, Princeton, NJ, USA
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Pulcini C, Huttner A. CMI policy on antimicrobial stewardship research. Clin Microbiol Infect 2018; 24:91-92. [DOI: 10.1016/j.cmi.2017.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/04/2017] [Indexed: 12/18/2022]
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27
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Thilly N, Pulcini C. Reliability of self-reported recent antibiotic use among the general population: a cross-sectional study: author's response. Clin Microbiol Infect 2018; 24:87-88. [DOI: 10.1016/j.cmi.2017.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
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Le Marechal M, Fressard L, Agrinier N, Verger P, Pulcini C. General practitioners' perceptions of vaccination controversies: a French nationwide cross-sectional study. Clin Microbiol Infect 2017; 24:858-864. [PMID: 29104170 DOI: 10.1016/j.cmi.2017.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/12/2017] [Accepted: 10/28/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We aimed to study general practitioners' (GPs') perceptions of vaccines that have been a subject of controversy in France. METHODS A cross-sectional survey in 2014 asked a representative national sample of GPs, randomly selected from the exhaustive database of health professionals in France, about their perceptions of the likelihood of serious adverse events potentially associated with six different vaccines: for two of them the association was based on some scientific evidence, whereas for the other four this is not the case. We performed a cluster analysis to construct a typology of GPs' perceptions about the likelihood of these potential six associations. Factors associated with certain clusters of interest were identified using logistic regression models. RESULTS Overall, 1582 GPs participated in the questionnaire survey (1582/1712 GPs who agreed to participate, 92%). Cluster analysis identified four groups of GPs according to their susceptibility to vaccine controversies: 1) limited susceptibility to controversies (52%); 2) overall unsure, but rejected the association between hepatitis B vaccine and multiple sclerosis (32%); 3) highly susceptible to controversies (11%); and 4) unsure (5%). We found that GPs who occasionally practised alternative medicine (OR 2.71, 95% CI 1.65-4.45), and those who considered information provided by mass media as reliable (OR 2.04, 95% CI 1.65-3.99) were more susceptible to controversies. CONCLUSIONS GPs had different profiles of susceptibility to vaccination controversies, and most of their perceptions of these controversies were not based on scientific evidence.
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Affiliation(s)
- M Le Marechal
- Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - L Fressard
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - N Agrinier
- Université de Lorraine, EA 4360 APEMAC, Nancy, France; INSERM, CIC-1433 Epidémiologie clinique, CHRU de Nancy, Nancy, France
| | - P Verger
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France; INSERM, F-CRIN, I-Reivac (Innovative clinical research network in vaccinology), France
| | - C Pulcini
- Université de Lorraine, EA 4360 APEMAC, Nancy, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France.
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Le Maréchal M, Fressard L, Raude J, Verger P, Pulcini C. General practitioners and vaccination of children presenting with a benign infection. Med Mal Infect 2017; 48:44-52. [PMID: 29113691 DOI: 10.1016/j.medmal.2017.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the self-reported vaccination behavior of general practitioners (GPs) when asked whether they would recommend the vaccination of a child presenting with a febrile uncomplicated common cold. METHODS We performed a cross-sectional survey in 2014 on a national sample of GPs. GPs were randomly assigned to one of eight clinical vignettes, all describing a child presenting with an uncomplicated febrile common cold, but differing by age (4 or 11 months), temperature (38°C or 39°C), and the mother's emotional state (calm or worried). GPs were asked whether they would recommend immediate vaccination of the child with a hexavalent vaccine (diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B), or postpone it. We investigated the relation between the GPs' recommendation to vaccinate, the clinical vignette's variables, and the GPs' perceptions, attitudes, and practices toward vaccination in a multivariate model. RESULTS Among the 1582 participating GPs, 6% recommended immediate vaccination. This behavior was more frequent with a temperature of 38°C rather than 39°C (10% vs. 3%, P<0.001). GPs who felt comfortable giving explanations about vaccine safety were more likely to recommend immediate vaccination of the febrile child (P=0.045), but none of the other GPs' characteristics were associated with their vaccination behavior. CONCLUSIONS Almost all GPs postponed the hexavalent vaccination of the febrile child presenting with an uncomplicated viral disease; fever being the major factor affecting their decision. More research is needed on vaccination responses in sick children, as well as clearer guidelines.
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Affiliation(s)
- M Le Maréchal
- Université de Lorraine, EA 4360 APEMAC, 54000 Nancy, France.
| | - L Fressard
- Aix-Marseille université, UMR_S912, IRD, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France; Inserm, UMR_S912, « Sciences Économiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM), 13000 Marseille, France
| | - J Raude
- EHESP-Rennes, Sorbonne-Paris-Cité, 35043 Rennes, France; Aix-Marseille université, EPV-UMR_D 190 « Émergence des Pathologies Virales », 13000 Marseille, France
| | - P Verger
- Aix-Marseille université, UMR_S912, IRD, 13000 Marseille, France; Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), 13000 Marseille, France; Inserm, UMR_S912, « Sciences Économiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM), 13000 Marseille, France; Inserm, F-CRIN, I-Reivac (Innovative clinical research network in vaccinology), 75654 Paris, France
| | - C Pulcini
- Université de Lorraine, EA 4360 APEMAC, 54000 Nancy, France; Inserm, F-CRIN, I-Reivac (Innovative clinical research network in vaccinology), 75654 Paris, France; Service de maladies infectieuses et tropicales, CHRU de Nancy, 54000 Nancy, France
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Pulcini C. Antibiotic stewardship: update and perspectives. Clin Microbiol Infect 2017; 23:791-792. [DOI: 10.1016/j.cmi.2017.08.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 12/31/2022]
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Dyar OJ, Huttner B, Schouten J, Pulcini C. What is antimicrobial stewardship? Clin Microbiol Infect 2017; 23:793-798. [PMID: 28882725 DOI: 10.1016/j.cmi.2017.08.026] [Citation(s) in RCA: 374] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of the term 'antimicrobial stewardship' has grown exponentially in recent years, typically referring to programmes and interventions that aim to optimize antimicrobial use. Although antimicrobial stewardship originated within human healthcare, it is increasingly applied in broader contexts including animal health and One Health. As the use of the term 'antimicrobial stewardship' becomes more common, it is important to consider what antimicrobial stewardship is, as well as what it is not. AIMS To review the emergence and evolution of the term 'antimicrobial stewardship'. SOURCES We searched and reviewed existing literature and official documents, which mostly focused on antibiotics. We contacted the authors of the first publications that mentioned antimicrobial stewardship. CONTENT We describe the historical background behind how antimicrobial stewardship came into use in clinical settings. We discuss challenges emerging from the varied descriptions of antimicrobial stewardship in the literature, including an over-emphasis on individual prescriptions, an under-emphasis on the societal implications of antimicrobial use, and language translation problems. IMPLICATIONS To help address these challenges, we suggest viewing antimicrobial stewardship as a strategy, a coherent set of actions which promote using antimicrobials responsibly. We stress the continuous need for 'responsible use' to be defined and translated into context-specific and time-specific actions. Furthermore, we present examples of actions that can be undertaken within antimicrobial stewardship across human and animal health.
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Affiliation(s)
- O J Dyar
- Global Health-Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - B Huttner
- Division of Infectious Diseases and Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - J Schouten
- IQ Healthcare, Radboud University Medical Center, Geert Grote Plein 2, Nijmegen, The Netherlands
| | - C Pulcini
- Service des maladies infectieuses et tropicales, Centre hospitalier régional universitaire (CHRU) de Nancy, and EA 4360 APEMAC, Université de Lorraine, Nancy, France
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Castan B, Lesprit P, Alfandari S, Bonnet E, Diamantis S, Gauzit R, Kerneis S, Leroy J, Lescure X, Meyssonnier V, Mondain V, Pavese P, Rabaud C, Stahl JP, Tattevin P, Roblot F, Pulcini C. [Antibiotic stewardship: A 2017 update]. Med Mal Infect 2017; 47:439-442. [PMID: 28781198 DOI: 10.1016/j.medmal.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- B Castan
- Unité fonctionnelle d'infectiologie régionale, CH Ajaccio, 20303 Ajaccio, France
| | - P Lesprit
- Infectiologie transversale, service de biologie clinique, hôpital Foch, 92151 Suresnes, France
| | - S Alfandari
- Service de réanimation et maladies infectieuses, CH de Tourcoing, 59200 Tourcoing, France
| | - E Bonnet
- Équipe mobile d'infectiologie, hôpital Joseph-Ducuing, 31300 Toulouse, France
| | - S Diamantis
- Service des maladies infectieuses et tropicales, CH Sud Île-de-France, 77011 Melun, France
| | - R Gauzit
- Équipe mobile d'infectiologie, AP-HP, hôpitaux universitaires Paris centre-site Cochin, université Paris Descartes, 75014 Paris, France
| | - S Kerneis
- Équipe mobile d'infectiologie, AP-HP, hôpitaux universitaires Paris centre-site Cochin, université Paris Descartes, 75014 Paris, France
| | - J Leroy
- ARLIN BFC/PRIMAIR, service d'hygiène hospitalière et service de maladies infectieuses, CHRU de Besançon, 25030 Besançon, France
| | - X Lescure
- IAME UMR 1137 Inserm, service de maladies infectieuses et tropicales, AP-HP, hôpital Bichat-Claude Bernard, faculté Paris Diderot, 75018 Paris, France
| | - V Meyssonnier
- CRIOAC, médecine interne, groupe hospitalier Diaconesses-Croix-Saint-Simon, 75020 Paris, France
| | - V Mondain
- Service des maladies infectieuses, CHU de Nice, Nice, France
| | - P Pavese
- Infectiologie, CHU, université Grenoble Alpes, 38700 Grenoble, France
| | - C Rabaud
- EA 4360 APEMAC, service de maladies infectieuses, CHRU de Nancy, université de Lorraine, 54000 Nancy, France
| | - J P Stahl
- Infectiologie, CHU, université Grenoble Alpes, 38700 Grenoble, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, CHU de Rennes, hôpital Pontchaillou, 35033 Rennes, France
| | - F Roblot
- Service de médecine interne, maladies infectieuses et tropicales et Inserm U1070, CHU de Poitiers, 86021 Poitiers, France
| | - C Pulcini
- EA 4360 APEMAC, service de maladies infectieuses, CHRU de Nancy, université de Lorraine, 54000 Nancy, France.
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Pulcini C, Morel CM, Tacconelli E, Beovic B, de With K, Goossens H, Harbarth S, Holmes A, Howard P, Morris AM, Nathwani D, Sharland M, Schouten J, Thursky K, Laxminarayan R, Mendelson M. Human resources estimates and funding for antibiotic stewardship teams are urgently needed. Clin Microbiol Infect 2017; 23:785-787. [PMID: 28778544 DOI: 10.1016/j.cmi.2017.07.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/26/2022]
Affiliation(s)
- C Pulcini
- Lorraine University, EA 4360 APEMAC, Nancy, France; Nancy University Hospital, Infectious Diseases Department, Nancy, France; ESCMID Study Group for Antimicrobial stewardshiP (ESGAP).
| | - C M Morel
- University of Geneva Medical School, Geneva, Switzerland; London School of Economics, London, United Kingdom
| | - E Tacconelli
- Infectious Diseases, Internal Medicine 1, DZIF Centre, Tübingen University, Germany; European Committee on Infection Control (EUCIC)
| | - B Beovic
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP); University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - K de With
- University Hospital Carl Gustav Carus at the TU Dresden, Division of Infectious Diseases, Dresden, Germany
| | - H Goossens
- Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - S Harbarth
- Infection Control Program and Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - A Holmes
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - P Howard
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP); Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A M Morris
- Division of Infectious Diseases, Department of Medicine, Sinai Health System, University Health Network, University of Toronto, Toronto, Canada
| | - D Nathwani
- Ninewells Hospital and Medical School, Dundee, UK; British Society for Antimicrobial Chemotherapy (BSAC), Birmingham, UK
| | - M Sharland
- Paediatric Infectious Diseases Research Group, St George's, University of London, London, UK
| | - J Schouten
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP); IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - K Thursky
- National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute, Melbourne, Australia
| | - R Laxminarayan
- Centre for Disease Dynamics, Economics & Policy, New Delhi, India
| | - M Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Tattevin P, Pulcini C. Central nervous system infections: work in progress. Clin Microbiol Infect 2017; 23:599-600. [PMID: 28750919 DOI: 10.1016/j.cmi.2017.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/15/2017] [Accepted: 07/15/2017] [Indexed: 01/15/2023]
Affiliation(s)
- P Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France; ESCMID Study Group for Infectious Diseases of the Brain (ESGIB), France.
| | - C Pulcini
- Infectious Diseases Department, Nancy University Hospital, Nancy, France; EA 4360 APEMAC, Lorraine University, Nancy, France
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Diallo K, Kern W, Béraud G, Giannella M, Kofteridis D, Kostyanev T, Pardo J, Retamar P, Thilly N, Pulcini C. Prise en charge des bactériémies/fongémies : une enquête européenne. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pulcini C, Beovic B, Béraud G, Carlet J, Cars O, Howard P, Levy-Hara G, Li G, Nathwani D, Roblot F, Sharland M. Ensuring universal access to old antibiotics: a critical but neglected priority. Clin Microbiol Infect 2017; 23:590-592. [PMID: 28522030 DOI: 10.1016/j.cmi.2017.04.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 12/31/2022]
Affiliation(s)
- C Pulcini
- Lorraine University, EA 4360 APEMAC, Nancy, France; Nancy University Hospital, Infectious Diseases Department, Nancy, France; ESCMID Study Group for Antimicrobial stewardshiP (ESGAP), Basel, Switzerland.
| | - B Beovic
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP), Basel, Switzerland; University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - G Béraud
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP), Basel, Switzerland; Centre Hospitalier Universitaire de Poitiers, Department of Infectious Diseases, Université de Poitiers, Poitiers, France; Université Droit et Santé Lille 2, EA2694, Lille, France; Hasselt University, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt, Belgium; World Alliance Against Antibiotic Resistance (WAAAR), Paris, France
| | - J Carlet
- World Alliance Against Antibiotic Resistance (WAAAR), Paris, France
| | - O Cars
- ReAct - Action on Antibiotic Resistance, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - P Howard
- ESCMID Study Group for Antimicrobial stewardshiP (ESGAP), Basel, Switzerland; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G Levy-Hara
- ISC (International Society of Chemotherapy) Antimicrobial Stewardship Working Group, UK; Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - G Li
- Paediatric Infectious Diseases Research Group, St George's, University of London, London, UK
| | - D Nathwani
- British Society for Antimicrobial Chemotherapy (BSAC), Birmingham, UK
| | - F Roblot
- Centre Hospitalier Universitaire de Poitiers, Department of Infectious Diseases, Université de Poitiers, Poitiers, France; Société de Pathologie Infectieuse de Langue Française (SPILF, French Infectious Diseases Society), Paris, France
| | - M Sharland
- Paediatric Infectious Diseases Research Group, St George's, University of London, London, UK
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Dyar OJ, Tebano G, Pulcini C. Managing responsible antimicrobial use: perspectives across the healthcare system. Clin Microbiol Infect 2017; 23:441-447. [PMID: 28433726 DOI: 10.1016/j.cmi.2017.04.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/14/2017] [Accepted: 04/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Healthcare systems consist of building blocks. Shaping how these building blocks function and interact can promote responsible antimicrobial use, and this represents an important opportunity for managers at different points within healthcare systems to act upon. AIMS To review real-world examples of how healthcare systems can promote responsible antimicrobial use, focusing on the role of governance and managers. SOURCES We searched and reviewed existing literature and official documents, which mostly focused on antibiotics. We also drew on the diverse experiences of the ESGAP (the ESCMID (European Society of Clinical Microbiology and Infectious Diseases) Study Group for Antimicrobial stewardshiP) network. CONTENT First, we explored at the institution level the implementation of antimicrobial stewardship programmes, the need to embrace multidisciplinary approaches, the benefits of engaging with social sciences experts, and the role of governance and leadership. We look beyond individual institutions and highlight the urgent need for workforce capacity estimates for antimicrobial stewardship activities, how antimicrobial stewardship efforts can connect to form networks, and the importance of governance and regulation at national and international levels. IMPLICATIONS Managers in the healthcare system are in a strong position to look beyond individual prescriptions and to recognize the many ways in which different healthcare system building blocks can contribute to responsible use of antimicrobials. At the institution level this can be achieved by implementing antimicrobial stewardship programmes, ensuring they are adequately resourced, and driving buy-in across clinical leadership. At regional and national levels this includes facilitating the sharing of experiences and resources between institutions, and developing the standards and regulations needed to support responsible antimicrobial use.
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Affiliation(s)
- O J Dyar
- Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - G Tebano
- Service des maladies infectieuses, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - C Pulcini
- Service des maladies infectieuses et tropicales, Centre hospitalier régional universitaire (CHRU) de Nancy, and EA 4360 APEMAC, Université de Lorraine, Nancy, France.
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Pulcini C. Amoxicillin dosing recommendations are very different in European countries: a cross-sectional survey. Clin Microbiol Infect 2016; 23:414-415. [PMID: 27890458 DOI: 10.1016/j.cmi.2016.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022]
Affiliation(s)
- C Pulcini
- Centre Hospitalier Universitaire de Nancy, Service de Maladies Infectieuses et Tropicales, Hôpital de Brabois, Vandoeuvre-Lès-Nancy, France.
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Castan B, Lesprit P, Alfandari S, Bonnet E, Diamantis S, Gauzit R, Kernéis S, Leroy J, Lescure FX, Mondain V, Pavese P, Rabaud C, Stahl JP, Tattevin P, Roblot F, Pulcini C. [Antibiotic stewardship: What's new?]. Med Mal Infect 2016; 46:403-405. [PMID: 27856081 DOI: 10.1016/j.medmal.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/07/2016] [Indexed: 11/17/2022]
Affiliation(s)
- B Castan
- Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, 27, avenue Impératrice-Eugénie, 20303 Ajaccio, France
| | - P Lesprit
- Infectiologie transversale, service de biologie clinique, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - S Alfandari
- Service de réanimation et maladies infectieuses, centre hospitalier Tourcoing, 155, rue du Président-Coty, 59200 Tourcoing, France
| | - E Bonnet
- Équipe mobile d'infectiologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - S Diamantis
- Service des maladies infectieuses, centre hospitalier de Melun, 2, rue Fréteau-de-Peny, 77011 Melun cedex, France
| | - R Gauzit
- Réanimation Ollier, CHU Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - S Kernéis
- Fédération d'infectiologie, université Paris Descartes, UMR 1181, Institut Pasteur, hôpital Cochin, AP-HP, 75014 Paris, France
| | - J Leroy
- PRIMAIR (Programme régional interdisciplinaire pour la maîtrise de la résistance aux anti-infectieux) ARLin B-FC, service d'hygiène hospitalière de maladies infectieuses, CHU de Besançon, 3, boulevard A.-Fleming, 25030 Besançon, France
| | - F X Lescure
- Service des maladies infectieuses et UMR 1137, Inserm, faculté de Paris Diderot, hôpital Bichat-Claude-Bernard, AP-HP, 5, rue Thomas-Mann, 75013 Paris, France
| | - V Mondain
- Infectiologie, hôpital de L'Archet, CHU de Nice, 4, avenue Reine-Victoria, 06003 Nice, France
| | - P Pavese
- Maladies infectieuses, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - C Rabaud
- Fédération française d'infectiologie (CNP-FFI), 30, boulevard Pasteur, 75014 Paris, France
| | - J P Stahl
- Maladies infectieuses, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, Inserm U 835, université Rennes-I, hôpital Pontchaillou, rue du Thabor, 35000 Rennes, France
| | - F Roblot
- Service de médecine interne et maladies infectieuses, Inserm U1070, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - C Pulcini
- Service de maladies infectieuses et Tropicales, université de Lorraine, EA 4360 APEMAC, hôpitaux de Brabois, CHRU de Nancy, 54511 Vandœuvre-Lès-Nancy cedex, France.
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Mauffrey V, Kivits J, Pulcini C, Boivin JM. Perception of acceptable antibiotic stewardship strategies in outpatient settings. Med Mal Infect 2016; 46:285-93. [PMID: 27475666 DOI: 10.1016/j.medmal.2016.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 02/05/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Antibiotics are still often inappropriately prescribed in France despite specific measures being taken for over 10years. The 25% decrease in antibiotic prescription advocated in the 2011-2016 National Antibiotic Plan seems difficult to achieve. One of the strategies currently considered in France is the use of a specific prescription form dedicated to antibiotics, with an educational message for patients. We aimed to evaluate the acceptability - by primary care prescribers - of this measure and to evaluate their perception of other antibiotic stewardship strategies. METHODS Qualitative study conducted among family physicians, pediatricians, dermatologists, dentists, and ENT specialists using semi-structured interviews. A thematic and framework analysis was then performed. RESULTS Thirty prescribing physicians practicing in a specific region of France were included in the study. The dedicated prescription form for antibiotics was deemed excessive and questionable. Other measures, not directly targeting prescribers, were rather well perceived: the unit sales of antibiotics, the restricted reporting of susceptibility tests, or the limitation of the number of molecules available in outpatient settings. CONCLUSION The results of this exploratory study may guide the national antibiotic stewardship policy in France.
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Affiliation(s)
- V Mauffrey
- Département de médecine générale, université de Lorraine, faculté de médecine, 54000 Nancy, France; École de santé publique, université de Lorraine, faculté de médecine, 54000 Nancy, France; ANTIBIOLOR, CHU de Nancy, réseau Lorrain d'antibiologie, 54000 Nancy, France.
| | - J Kivits
- École de santé publique, université de Lorraine, faculté de médecine, 54000 Nancy, France; Épidémiologie et évaluation cliniques, CHU de Nancy, pôle QSP2, 54000 Nancy, France; EA4360 APEMAC, université de Lorraine, université Paris Descartes, 54000 Nancy, France
| | - C Pulcini
- ANTIBIOLOR, CHU de Nancy, réseau Lorrain d'antibiologie, 54000 Nancy, France; EA4360 APEMAC, université de Lorraine, université Paris Descartes, 54000 Nancy, France; Service de maladies infectieuses et tropicales, CHU de Nancy, 54000 Nancy, France
| | - J M Boivin
- Département de médecine générale, université de Lorraine, faculté de médecine, 54000 Nancy, France; ANTIBIOLOR, CHU de Nancy, réseau Lorrain d'antibiologie, 54000 Nancy, France; CIC-P Inserm, CHU de Nancy, 54000 Nancy, France
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Affiliation(s)
- C Pulcini
- CMI Editorial Office, France; Université de Lorraine, EA 4360 APEMAC and CHRU de Nancy, Hôpitaux de Brabois, Service de Maladies Infectieuses et Tropicales, Nancy, France.
| | - C Britt
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Basel, Switzerland
| | - H Saenz
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Basel, Switzerland
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Dickstein Y, Nir-Paz R, Pulcini C, Cookson B, Beović B, Tacconelli E, Nathwani D, Vatcheva-Dobrevska R, Rodríguez-Baño J, Hell M, Saenz H, Leibovici L, Paul M. Staffing for infectious diseases, clinical microbiology and infection control in hospitals in 2015: results of an ESCMID member survey. Clin Microbiol Infect 2016; 22:812.e9-812.e17. [PMID: 27373529 DOI: 10.1016/j.cmi.2016.06.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/16/2016] [Accepted: 06/21/2016] [Indexed: 10/24/2022]
Abstract
We aimed to assess the current status of infectious diseases (ID), clinical microbiology (CM) and infection control (IC) staffing in hospitals and to analyse modifiers of staffing levels. We conducted an Internet-based survey of European Society of Clinical Microbiology and Infectious Diseases members and affiliates, collecting data on hospital characteristics, ID management infrastructure, ID/IC-related activities and the ratio of physicians per 100 hospital beds. Regression analyses were conducted to examine factors associated with the physician-bed ratio. Five hundred sixty-seven hospital responses were collected between April and June 2015 from 61 countries, 81.2% (384/473) from Europe. A specialized inpatient ward for ID patients was reported in 58.4% (317/543) of hospitals. Rates of antibiotic stewardship programmes (ASP) and surveillance activities in survey hospitals were high, ranging from 88% to 90% for local antibiotic guidelines and 70% to 82% for programmes monitoring hospital-acquired infections. The median ID/CM/IC physician per 100 hospital beds ratio was 1.12 (interquartile range 0.56-2.13). In hospitals performing basic ASP and IC (including local antibiotic guidelines and monitoring device-related or surgical site infections), the ratio was 1.21 (interquartile range 0.57-2.14). Factors independently associated with higher ratios included compliance with European Union of Medical Specialists standards, smaller hospital size, tertiary-care institution, presence of a travel clinic, beds dedicated to ID and a CM unit. More than half of respondents estimated that additional staffing is needed for appropriate IC or ID management. No standard of physician staffing for ID/CM/IC in hospitals is available. A ratio of 1.21/100 beds will serve as an informed point of reference enabling ASP and infection surveillance.
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Affiliation(s)
- Y Dickstein
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - R Nir-Paz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - C Pulcini
- Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC and CHU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - B Cookson
- Division of Infection and Immunity, University College London, Gower Street, London, United Kingdom
| | - B Beović
- Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia
| | - E Tacconelli
- Division of Infectious Diseases, Department of Internal Medicine I, DZIF Center, Tübingen University Hospital, Tübingen, Germany
| | - D Nathwani
- Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom
| | - R Vatcheva-Dobrevska
- Department of Microbiology and Virology, University Hospital Queen Joanna, Sofia, Bulgaria
| | - J Rodríguez-Baño
- Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain; Departamento de Medicina, Universidad de Sevilla, Seville, Spain
| | - M Hell
- Department of Hospital Epidemiology and Infection Control, University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - H Saenz
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Basel, Switzerland
| | - L Leibovici
- Medicine E, Rabin Medical Centre, Beilinson Hospital, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M Paul
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine-Technion, Israel Institute of Technology, Haifa, Israel.
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Bourdellon L, Pulcini C, Fougnot S, May T, Rabaud C, Hénard S. COL 1-02 - Impact et acceptation de l’antibiogramme ciblé sur la prescription d’antibiotiques en médecine générale à l’échelle d’une région française. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Agrinier N, Le Maréchal M, Fressard L, Verger P, Pulcini C. COL 5-05 - Discordances chez les médecins généralistes entre la vaccination de leurs patients et celle de leur(s) enfant(s) : une étude transversale. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30280-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Baux E, Aissa N, Pulcini C, May T, Lozniewski A, Rabaud C, Hénard S. BU-34 - Impact d’une antibiothérapie alternative aux carbapénèmes sur la mortalité dans le traitement des infections urinaires fébriles à eblse. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dyar O, Nathwani D, Gyssens I, Stålsby Lundborg C, Pulcini C. BU-10 - Enquête nationale menée auprès des étudiants en médecine sur l’enseignement du bon usage des antibiotiques. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lemaire X, Bonnet E, Castan B, Forestier E, Lescure FX, Roblot F, Pulcini C. Management of non-necrotizing cellulitis in France. Med Mal Infect 2016; 46:355-359. [PMID: 27238366 DOI: 10.1016/j.medmal.2016.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 01/12/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aimed to assess medical practices of French infectious disease specialists or any other relevant physicians related to the management of non-necrotizing cellulitis (NNC). METHODS We sent an online questionnaire to members of the French Infectious Diseases Society (SPILF) mailing list in September 2015. RESULTS A total of 108 specialists took part in the survey and 10% (11/107) declared to always admit NNC patients to hospital. As for the others, 18% declared to admit patients in more than 80% of cases, 49% in 50-80% of cases, 26% in 20-50% of cases, and 7% in less than 20% of cases. The most frequent criteria for hospital admission were severe sepsis/septic shock (99%), poor social conditions (99%), rapid extension of skin lesions (93%), high level of pain (86%), and failure of first-line antibiotic therapy (84%). Participants mentioned similar criteria for reasons to initiate the intravenous (IV) antibiotic therapy. Fifty-three percent of respondents declared initiating antibiotic therapy using the IV route in more than 80% of cases. Physicians declared that the usual antibiotic therapy duration were <7 days (6%), 8-10 days (57%), 11-14 days (34%), and >15 days (3%). CONCLUSION Criteria for hospital admission and use of the IV route for antibiotic therapy as well as optimal treatment duration in patients presenting with NNC need to be detailed in guidelines and evaluated in prospective studies.
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Affiliation(s)
- X Lemaire
- Service maladies infectieuses, CH de Douai, 59500 Douai, France.
| | - E Bonnet
- Unité mobile d'infectiologie, hôpital J.-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - B Castan
- Centre hospitalier d'Ajaccio, 20000 Ajaccio, France
| | - E Forestier
- Service de maladies infectieuses et médecine interne, centre hospitalier de Chambéry, 73011 Chambéry cedex, France
| | - F-X Lescure
- Service de maladies infectieuses et tropicales, hôpital Bichat, AP-HP, Inserm, IAME, UMR 1137, université Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - F Roblot
- Médecine interne et département de maladies infectieuses, Inserm U1070, université de Poitiers, 86000 Poitiers, France
| | - C Pulcini
- Université de Lorraine, université Paris Descartes, EA 4360 APEMAC, 54505 Vandœuvre-lès-Nancy cedex, France; Service de maladies infectieuses et tropicales, hôpitaux de Brabois, CHU de Nancy, 54511 Vandœuvre-lès-Nancy cedex, France
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Charmillon A, Novy E, Agrinier N, Leone M, Kimmoun A, Levy B, Demoré B, Dellamonica J, Pulcini C. The ANTIBIOPERF study: a nationwide cross-sectional survey about practices for β-lactam administration and therapeutic drug monitoring among critically ill patients in France. Clin Microbiol Infect 2016; 22:625-31. [PMID: 27145210 DOI: 10.1016/j.cmi.2016.04.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/16/2016] [Accepted: 04/23/2016] [Indexed: 11/25/2022]
Abstract
Our objective was to assess current practices about the administration (intermittent, extended, or continuous infusions) and therapeutic drug monitoring (TDM) of β-lactam antibiotics and vancomycin in France. We conducted a nationwide cross-sectional survey in May-August 2015, using an online questionnaire, sent as an e-mail link to infectious disease specialists and intensive care specialists through national mailing lists. We used clinical vignettes of critically ill patients to assess physicians' practices about administration and TDM practices for amoxicillin, cloxacillin, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, meropenem and vancomycin. In all, 507 physicians participated (507/1200, response rate 42%). TDM was rarely available for β-lactams (from 16.5% (81/490) for cloxacillin to 30% (145/490) for ceftazidime), whereas vancomycin TDM was available in 97% (477/490) of the cases. In the clinical vignettes, ceftazidime and piperacillin/tazobactam were the β-lactams administered most frequently by extended or continuous infusions (76% (336/440) and 57% (252/444), respectively). Gaps in knowledge about the duration of stability of intravenous β-lactams were common (correct answers ranged from 8% (35/432) for cloxacillin to 33% (146/438) for ceftazidime). Most physicians (77%, 339/442) were convinced of the value of extended or continuous infusions for β-lactams in critically ill patients, but 48% (211/442) did not have access to practical guidelines. Our survey found that most infectious disease and intensive care specialists are favourable to optimized administration of β-lactams in critically ill patients. But the lack of guidelines and limited TDM availability for β-lactams in hospitals are potential barriers to its implementation.
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Affiliation(s)
- A Charmillon
- CHU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France; Université de Lorraine, Nancy, France
| | - E Novy
- Université de Lorraine, Nancy, France; CHU de Nancy, Service de Réanimation Médicale Brabois, Nancy, France
| | - N Agrinier
- CHU de Nancy, Inserm, CIC-1433 Epidémiologie Clinique, Nancy, France; Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - M Leone
- Université de Marseille, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'anesthésie et de Réanimation, Marseille, France
| | - A Kimmoun
- CHU de Nancy, Service de Réanimation Médicale Brabois, Nancy, France; Université de Lorraine, Inserm U1116, Nancy, France
| | - B Levy
- CHU de Nancy, Service de Réanimation Médicale Brabois, Nancy, France; Université de Lorraine, Inserm U1116, Nancy, France
| | - B Demoré
- CHU de Nancy, Pharmacie de Brabois, Nancy, France; Université de Lorraine, SRSMC, UMR 7565, Nancy, France
| | - J Dellamonica
- CHU de Nice, Service de réanimation médicale, Nice, France; Université de Nice Sophia Antipolis, INSERM 1065 team 3 'Metabolic Control of cell death' C3M Nice, Nice, France
| | - C Pulcini
- CHU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France; Université de Lorraine, EA 4360 APEMAC, Nancy, France; Antibiolor, Nancy, France.
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Le Coz P, Carlet J, Roblot F, Pulcini C. Human resources needed to perform antimicrobial stewardship teams' activities in French hospitals. Med Mal Infect 2016; 46:200-6. [PMID: 27021932 DOI: 10.1016/j.medmal.2016.02.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/17/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In January 2015, the French ministry of Health set up a task force on antibiotic resistance. Members of the task force's "antimicrobial stewardship" group conducted a study to evaluate the human resources needed to implement all the required activities of the multidisciplinary antimicrobial stewardship teams (AST - antibiotic/infectious disease lead supervisors, microbiologists, and pharmacists) in French healthcare facilities. METHODS We conducted an online cross-sectional nationwide survey. The questionnaire was designed based on regulatory texts and experts' consensus. The survey took place between March and May 2015. We used the mailing list of the French Infectious Diseases Society (SPILF) to send out questionnaires. RESULTS A total of 65 healthcare facilities completed the questionnaire. The human resources needed to implement all AST's activities were estimated at 3.6 full-time equivalent (FTE) positions/1000 acute care beds for antibiotic/infectious disease lead supervisors, at 2.5 FTE/1000 beds for pharmacists, and at 0.6 FTE/1000 beds for microbiologists. This almost amounts to a total of 2000 FTE positions for all healthcare facilities (public and private) in France and to an annual cost of 200 million euros. CONCLUSION Dedicated and sustainable funding for AST is urgently needed to implement comprehensive and functional AST programs in all healthcare facilities.
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Affiliation(s)
- P Le Coz
- Inserm, IAME, UMR 1137, UFR de médecine Paris 7 Denis-Diderot, 16, rue Henri-Huchard, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 16, rue Henri-Huchard 75018 Paris, France.
| | - J Carlet
- World Alliance Against Antimicrobial Resistance (WAAAR), 92100 Boulogne-Billancourt, France
| | - F Roblot
- Inserm 1070, faculté de médecine et de pharmacie, université de Poitiers, 86022 Poitiers, France; Service de médecine interne et maladies infectieuses, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - C Pulcini
- EA 4360 APEMAC, faculté de médecine, université de Lorraine, université Paris Descartes, 9, avenue de la Forêt-de-Haye, 54505 Vandœuvre-lès-Nancy cedex, France; Service de maladies infectieuses et tropicales, hôpitaux de Brabois, CHU de Nancy, bâtiment des spécialités médicales, allée du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France
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Weiss E, Zahar JR, Lesprit P, Ruppe E, Leone M, Chastre J, Lucet JC, Paugam-Burtz C, Brun-Buisson C, Timsit JF, Brun-Buisson C, Bruneel F, Chastre J, Lasocki S, Leone M, Montravers P, Nseir S, Paugam-Burtz C, Pease S, Timsit JF, Weiss E, Wolff M, Alfandari S, Fantin B, Gachot B, Lesprit P, Lucet JC, Potel G, Pulcini C, Rabaud C, Tattevin P, Armand-Lefevre L, Cavallo JD, Jarlier V, Joint-Lambert O, Robert J, Ruppé E, Woerther P. Corrigendum to ‘Elaboration of a consensual definition of de-escalation allowing a ranking of β-lactams’ [Clin Microbiol Infec 21 (2015) 649.e1–649.e10]. Clin Microbiol Infect 2015. [DOI: 10.1016/j.cmi.2015.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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