Clinical Microbiology and Infection

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Presentation transcript:

Clinical Microbiology and Infection A European survey of antibiotic management of methicillin-resistant Staphylococcus aureus infection: current clinical opinion and practice M. Dryden, A.T. Andrasevic, M. Bassetti, E. Bouza, J. Chastre, G. Cornaglia, S. Esposito, G. French, H. Giamarellou, I.C. Gyssens, D. Nathwani, S. Unal, A. Voss Clinical Microbiology and Infection Volume 16, Pages 3-30 (March 2010) DOI: 10.1111/j.1469-0691.2010.03135.x Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 1 If true community-acquired MRSA infection becomes more common in Europe, do you think that this will alter empirical antibiotic choices for community-acquired staphylococcal infection? (Question 3.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 2 Which is the most frequent infection caused by MRSA in your practice? (Question 4.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 3 Which is the most common focus of MRSA bloodstream infections in your practice? (Question 5.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; IV, intravenous; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 4 Are oral antibiotics ever justified for the initial treatment of proven MRSA infection in the following? (Check all that apply.) (Question 8.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 5 If oral drugs are acceptable, which oral treatment would you consider for the initial treatment of serious MRSA infection, providing that the isolate is susceptible to the drug? (Check all that apply.) (Question 9.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 6 What is your minimum total duration of therapy in MRSA bacteraemia due to a line infection if the line has been removed and there is no evidence of another focus (e.g. endocarditis)? (Question 11.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 7 What do you regard as the optimal total duration of therapy for MRSA pneumonia? (Question 12.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 8 For the management of MRSA infections, what are the top three factors that most influence your antibiotic choice? (Check three factors.) (Question 13.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 9 For the management of MRSA infections, what are the top three health economic factors that most influence your antibiotic choice? (Check three factors.) (Question 14.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; ICU, intensive-care unit; IV, intravenous; MRSA, methicillin-resistant Staphylococcus aureus; QALY, quality-adjusted life-year. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 10 Once the patient is stable, would you consider outpatient parenteral antibiotic therapy (OPAT) for the management of MRSA infections? (Check all that apply.) (Question 15.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; IV, intravenous; MRSA, methicillin-resistant Staphylococcus aureus. Outpatient IV therapy is unnecessary because oral switch is usually appropriate. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 11 For a complicated skin and soft tissue infection caused by MRSA, what would be your initial IV treatment? (Question 19.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; IV, intravenous; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 12 Assuming that the causative strain of MRSA is susceptible to the drug, what would you use for early oral switch in patients with complicated skin and soft tissue infection? (Question 20.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 13 For minor infection of soft tissue caused by MRSA and not requiring hospitalization, what antibiotic would you choose? (Question 21.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 14 For a confirmed MRSA bacteraemia, what is your (a) first-line and (b) second-line treatment? (Question 24.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 15 When MRSA pneumonia (HCAP/HAP/VAP) is confirmed, what do you regard as the most appropriate treatment regimen? (Question 27.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; HAP, hospital-acquired pneumonia; HCAP, healthcare-associated pneumonia; MRSA, methicillin-resistant Staphylococcus aureus; VAP, ventilator-associated pneumonia. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 16 Do you use the glycopeptide minimum inhibitory concentration (MIC) routinely to guide your choice of treatment? (Question 28.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 17 At which vancomycin MIC level for MRSA (by Etest) would you replace vancomycin with an alternative antibiotic? (Question 29.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions

FIG. 18 What do you regard as the most appropriate anti-MRSA agent for the treatment of serious MRSA infection in patients infected by strains with reduced vancomycin susceptibility? (Question 30.) ECCMID, European Congress of Clinical Microbiology and Infectious Diseases; MRSA, methicillin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 2010 16, 3-30DOI: (10.1111/j.1469-0691.2010.03135.x) Copyright © 2010 European Society of Clinical Infectious Diseases Terms and Conditions