Nebulization of antimicrobial agents in mechanically ventilated adults in 2017: an international cross-sectional survey.

Details

Serval ID
serval:BIB_0B76C6764CB0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Nebulization of antimicrobial agents in mechanically ventilated adults in 2017: an international cross-sectional survey.
Journal
European journal of clinical microbiology & infectious diseases
Author(s)
Alves J., Alp E., Koulenti D., Zhang Z., Ehrmann S., Blot S., Bassetti M., Conway-Morris A., Reina R., Teran E., Sole-Lleonart C., Ruiz-Rodríguez M., Rello J.
Working group(s)
SANEME-2 Investigators
ISSN
1435-4373 (Electronic)
ISSN-L
0934-9723
Publication state
Published
Issued date
04/2018
Peer-reviewed
Oui
Volume
37
Number
4
Pages
785-794
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
2017 ESCMID practice guidelines reported safety concerns and weak evidence of benefit supporting use of aerosolized antibiotics in mechanically ventilated patients. Our primary goal was to assess current patterns of aerosolized antibiotic prescription in mechanically ventilated patients. A sequential global survey was performed prior to the release of the ESCMID guidelines, from the 1st of February to the 30th of April 2017, using an electronic platform. Responses were analyzed comparing geographical regions. A total of 410 units responded, with 261 (177 from Europe) being eligible for the full survey. 26.8% of units reported not using aerosolized antibiotics. The two major indications amongst prescribing units were ventilator-associated pneumonia and ventilator-associated tracheobronchitis (74.3% and 49.4%, respectively). 63.6% of units indicated prescription solely in response to multi-drug resistant organisms. In comparison with a survey undertaken in 2014, there was a significant reduction in use of aerosolized antibiotics for prophylaxis (50.6% vs 7.7%, p < 0.05) and colonization (52.9% vs 25.3%, p < 0.05). The large majority of units (91.7%) reported only prescribing in patients with positive pulmonary cultures. Asia appeared to be an outlier, with 53.3% of units reporting empirical use. The most commonly used device was the jet nebulizer. The most commonly prescribed drugs were colistin methanesulfonate (57.6%), colistin base (41.9%) and amikacin (31.4%), although there was considerable heterogeneity across geographical areas. A significant gap exists between ESCMID clinical practice recommendations and the use of aerosolized antibiotics in clinical practice. Our findings indicate an urgent need for high-quality education to bring practice into line with evidence-based guidelines.
Keywords
Administration, Inhalation, Anti-Infective Agents/administration & dosage, Anti-Infective Agents/therapeutic use, Cross-Sectional Studies, Humans, Nebulizers and Vaporizers/statistics & numerical data, Nebulizers and Vaporizers/utilization, Respiration, Artificial/methods, Respiration, Artificial/statistics & numerical data, Respiratory Tract Infections/drug therapy, Respiratory Tract Infections/epidemiology
Pubmed
Web of science
Create date
04/09/2018 11:47
Last modification date
20/08/2019 12:33
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