Antibiotic treatment of infections caused by carbapenem-resistant Gram-negative bacilli: an international ESCMID cross-sectional survey among infectious diseases specialists practicing in large hospitals

107noneObjectives: To explore contemporary antibiotic management of infections caused by carbapenem-resistant Gram-negative bacteria in hospitals.Methods: Cross-sectional, internet-based questionnaire survey. We contacted representatives of all hospitals with more than 800 acute-care hospital beds in France, Greece, Israel, Italy, Kosovo, Slovenia, Spain and selected hospitals in the USA. We asked respondents to describe the most common actual practice at their hospital regarding management of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa through close-ended questions.Results: Between January and June 2017, 115 of 141 eligible hospitals participated (overall response rate 81.6%, country-specific rates 66.7%-100%). Most were tertiary-care (99/114, 86.8%), university-affiliated (110/115, 89.1%) hospitals and most representatives were infectious disease specialists (99/115, 86.1%). Combination therapy was prescribed in 114/115 (99.1%) hospitals at least occasionally. Respondents were more likely to consider combination therapy when treating bacteraemia, pneumonia and central nervous system infections and for Enterobacteriaceae, P. aeruginosa and A. baumannii similarly. Combination of a polymyxin with a carbapenem was used in most cases, whereas combinations of a polymyxin with tigecycline, an aminoglycoside, fosfomycin or rifampicin were also common. Monotherapy was used for treatment of complicated urinary tract infections, usually with an aminoglycoside or a polymyxin. The intended goal of combination therapy was to improve the effectiveness of the treatment and to prevent development of resistance. In general, respondents shared the misconception that combination therapy is supported by strong scientific evidence.Conclusions: Combination therapy was the preferred treatment strategy for infections caused by carbapenem-resistant Gram-negative bacteria among hospital representatives, even though high-quality evidence for carbapenem-based combination therapy is lacking. (c) 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.nonePapst, L.*; Beović, B.; Pulcini, C.; Durante-Mangoni, E.; Rodríguez-Baño, J.; Kaye, K.S.; Daikos, G.L.; Raka, L.; Paul, M.; Abbo, L.; Abgueguen, P.; Almirante, B.; Azzini, A.M.; Bani-Sadr, F.; Bassetti, M.; Ben-Ami, R.; Beović, B.; Béraud, G.; Botelho-Nevers, E.; Bou, G.; Boutoille, D.; Cabié, A.; Cacopardo, B.; Cascio, A.; Cassir, N.; Castelli, F.; Cecala, M.; Charmillon, A.; Chirouze, C.; Cisneros, J.M.; Colmenero, J.D.; Coppola, N.; Corcione, S.; Daikos, G.L.; Dalla Gasperina, D.; De la Calle Cabrera, C.; Delobel, P.; Di Caprio, D.; Durante Mangoni, E.; Dupon, M.; Ettahar, N.; Falagas, M.E.; Falcone, M.; Fariñas, M.C.; Faure, E.; Forestier, E.; Foti, G.; Gallagher, J.; Gattuso, G.; Gendrin, V.; Gentile, I.; Giacobbe, D.R.; Gogos, C.A.; Grandiere Perez, L.; Hansmann, Y.; Horcajada, J.P.; Iacobello, C.; Jacob, J.T.; Justo, J.A.; Kernéis, S.; Komnos, A.; Kotnik Kevorkijan, B.; Lebeaux, D.; Le Berre, R.; Lechiche, C.; Le Moxing, V.; Lescure, F.X.; Libanore, M.; Martinot, M.; Merino de Lucas, E.; Mondain, V.; Mondello, P.; Montejo, M.; Mootien, J.; Muñoz, P.; Nir-Paz, R.; Pan, A.; Paño-Pardo, J.R.; Patel, G.; Paul, M.; Pérez Rodríguez, M.T.; Piroth, L.; Pogue, J.; Potoski, B.A.; Pourcher, V.; Pyrpasopoulou, A.; Rahav, G.; Rizzi, M.; Rodríguez-Baño, J.; Salavert, M.; Scheetz, M.; Sims, M.; Spahija, G.; Stefani, S.; Stefos, A.; Tamma, P.D.; Tattevin, P.; Tedesco, A.; Torre-Cisneros, J.; Tripolitsioti, P.; Tsiodras, S.; Uomo, G.; Verdon, R.; Viale, P.; Vitrat, V.; Weinberger, M.; Wiener-Well, Y.Papst, L.; Beović, B.; Pulcini, C.; Durante-Mangoni, E.; Rodríguez-Baño, J.; Kaye, K. S.; Daikos, G. L.; Raka, L.; Paul, M.; Abbo, L.; Abgueguen, P.; Almirante, B.; Azzini, A. M.; Bani-Sadr, F.; Bassetti, M.; Ben-Ami, R.; Beović, B.; Béraud, G.; Botelho-Nevers, E.; Bou, G.; Boutoille, D.; Cabié, A.; Cacopardo, B.; Cascio, A.; Cassir, N.; Castelli, F.; Cecala, M.; Charmillon, A.; Chirouze, C.; Cisneros, J. M.; Colmenero, J. D.; Coppola, N.; Corcione, S.; Daikos, G. L.; Dalla Gasperina, D.; De la Calle Cabrera, C.; Delobel, P.; Di Caprio, D.; Durante Mangoni, E.; Dupon, M.; Ettahar, N.; Falagas, M. E.; Falcone, M.; Fariñas, M. C.; Faure, E.; Forestier, E.; Foti, G.; Gallagher, J.; Gattuso, G.; Gendrin, V.; Gentile, I.; Giacobbe, D. R.; Gogos, C. A.; Grandiere Perez, L.; Hansmann, Y.; Horcajada, J. P.; Iacobello, C.; Jacob, J. T.; Justo, J. A.; Kernéis, S.; Komnos, A.; Kotnik Kevorkijan, B.; Lebeaux, D.; Le Berre, R.; Lechiche, C.; Le Moxing, V.; Lescure, F. X.; Libanore, M.; Martinot, M.; Merino de Lucas, E.; Mondain, V.; Mondello, P.; Montejo, M.; Mootien, J.; Muñoz, P.; Nir-Paz, R.; Pan, A.; Paño-Pardo, J. R.; Patel, G.; Paul, M.; Pérez Rodríguez, M. T.; Piroth, L.; Pogue, J.; Potoski, B. A.; Pourcher, V.; Pyrpasopoulou, A.; Rahav, G.; Rizzi, M.; Rodríguez-Baño, J.; Salavert, M.; Scheetz, M.; Sims, M.; Spahija, G.; Stefani, S.; Stefos, A.; Tamma, P. D.; Tattevin, P.; Tedesco, A.; Torre-Cisneros, J.; Tripolitsioti, P.; Tsiodras, S.; Uomo, G.; Verdon, R.; Viale, P.; Vitrat, V.; Weinberger, M.; Wiener-Well, Y

Outcomes from elective colorectal cancer surgery during the SARS‐CoV‐2 pandemic

Aim This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). Conclusion Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks