Letteratura



  • Kollef MH, Bassetti M, Francois B, Burnham J, Dimopoulos G, Garnacho-Montero J, Lipman J, Luyt CE, Nicolau DP, Postma MJ, Torres A, Welte T, Wunderink RG. The intensive care medicine research agenda on multidrug - resistant bacteria, antibiotics, and stewardship. Intensive Care Med. 2017 Feb 4. doi: 10.1007/s00134-017-4682-7. [Epub ahead of print]. Purpose: To concisely describe the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to the management of multidrug-resistant (MDR) bacteria, antibiotic use, and antimicrobial stewardship in the intensive care unit (ICU) setting. Methods - Narrative review based on a systematic analysis of the medical literature, national and international guidelines, and expert opinion. Results - The prevalence of infection of critically ill patients by MDR bacteria is rapidly evolving. Clinical studies aimed at improving understanding of the changing patterns of these infections in ICUs are urgently needed. Ideal antibiotic utilization is another area of uncertainty requiring additional investigations aimed at better understanding of dose optimization, duration of therapy, use of combination treatment, aerosolized antibiotics, and the integration of rapid diagnostics as a guide for treatment. Moreover, there is an imperative need to develop non-antibiotic approaches for the prevention and treatment of MDR infections in the ICU. Finally, clinical research aimed at demonstrating the beneficial impact of antimicrobial stewardship in the ICU setting is essential. Conclusions - These and other fundamental questions need to be addressed over the next decade in order to better understand how to prevent, diagnose, and treat MDR bacterial infections. Clinical studies described in this research agenda provide a template and set priorities for investigations that should be performed in this field.
  • Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock
  • Bloodstream infections: the most common type of healthcare-associated infections in children in Europe. A study published by The Lancet Infectious Diseases establishes the prevalence and type of healthcare-associated infections (HAIs) in children in Europe and describes risk factors for infection in this population. The study was based on data from the ECDC point prevalence survey of HAIs and antimicrobial use in European acute care hospitals 2011-2012, and included 770 infections reported in 726 children and adolescents. The findings show that the prevalence of infections was highest in paediatric intensive care units (15.5% - one in six children) and neonatal intensive care units (10.7% - one in ten babies). Most HAIs (77%) were identified in infants younger than 12 months. Bloodstream infections were the most common type of infection (45%), followed by lower respiratory tract infections (22%). Although the vast majority of bloodstream infections in the study were reported in infants younger than 12 months, the proportion remained high in other age groups as well. This type of infections in neonates and children are associated with a high mortality and long-term adverse neurological outcomes. The authors stated that a pan-European programme is urgently required to prevent and reduce the unacceptably high rates of HAIs in children in Europe, with a focus in neonatal and paediatric intensive care units and addressing the issues related to healthcare-associated bloodstream infections. This is the largest multinational study describing HAIs in children so far, providing detailed information about the prevalence and distribution of these infections in this specific population. A second point prevalence survey is ongoing in Europe, including improvements to address some of the limitations found during the development of the study, and its results will be published by the European Centre for Disease Prevention and Control after 2017.
  • Grundmann H, Glasner C, Albiger B et al. Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichiacoli in the European survey of carbapenemase-producing Enterobacteriaceae(EuSCAPE): a prospective, multinational study. Lancet Infectious Diseases.​The global rise of carbapenemase-producing Enterobacteriaceae (CPE) is alarming and is an increasing threat to patient safety, in Europe and globally. It results in higher healthcare costs, prolonged hospital stays, treatment failures and sometimes death. In 2012, the European Centre for Disease Prevention and Control (ECDC) launched the the “European Survey on Carbapenamase-Producing Enterobacteriaceae''' (EuSCAPE) project with the aim to gather data on the occurrence of CPE in Europe and build laboratory capacity for their diagnosis and for surveillance. On the occasion of the 9th European Antibiotic Awareness Day, on 18 November 2016, The Lancet Infectious Diseases published the results of characterisation, including carbapenemase production, of 1397 carbapenem-resistant Enterobacteriaceae isolates collected in 455 European hospitals from 36 countries during the EuSCAPE project, giving the first complete snapshot of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Europe. The surve​y showed that on average in Europe, 1.3 patients per 10 000 hospital admissions had a carbapenemase-producing K. pneumoniae or E. coli infection, with the highest incidence found in southern and southeastern Europe. In K. pneumoniae, the most frequently detected carbapenamases were KPC enzymes, followed by OXA-48-like, NDM and VIM, while in E. coli, there were OXA-48-like enzymes followed by NDM and KPC. The EuSCAPE project contributed to the improvement of the capacity and ability to detect CPE in European countries by creating a European network of national reference/expert laboratories able to provide information for monitoring incidence and spread of carbapenemases and CPE. These results highlight the need to develop a system for public health surveillance of CPE across healthcare systems in Europe as a tool to inform risk assessment and control programmes.
  • Action on Antimicrobial resistance in EU/EEA Members States: Good progress but more to do. Public Health - 09 September 2016.The Commission published a report prepared by the University of Bordeaux on the implementation of the Council recommendation of 15 November 2001 (2002/77/EC) on the prudent use of antimicrobial agents in human medicine. The report is based on questionnaires completed by EU and EEA Member States in 2015, which were analysed by the Bordeaux researchers. 20 out of the 29 countries providing information for the report had defined a strategy to promote prudent use of antimicrobial agents and contain antimicrobial resistance; six reported that they were in the process of developing strategies and /or actions plans and 3 had neither an AMR strategy nor a plan to create one. In most countries action plans included measures regarding surveillance, prudent use of antimicrobial agents, information and education. Detection and control of outbreaks, research and the use of rapid diagnostic tests (RDTs) were also commonly included. Nursing homes and long term care facilities were covered by 14 out of the 21 action plans. The Recommendation (2002/77/EC) aims to address the threat of antimicrobial resistance (AMR) and asks Member States to develop strategies comprising measures in relation to surveillance, education, information, prevention and control, and research. The report published today will feed into work on establishing new EU initiatives to take forward EU action against the rising threat from antimicrobial resistance. Scarica il report Per ulteriori informazioni vedi:Directorate-General for Health and Food SafetyEuropean Centre for Disease Prevention and Control