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

Alves, Joana;Alp, Emine;Koulenti, Despoina;Zhang, Zhongheng;SANEME-2 Investigators;et.al.
(2018) Eur J of Clin Micr & Inf Dis : official publication of the European Society of Clinical Microbiology — Vol. 37, n° 4, p. 785-794 (2018)

Files

AlvesJEurJClinMicrobiolInfectDis2018.pdf
  • Open Access
  • Adobe PDF
  • 680.75 KB
Download

Details

Authors
  • Alves, Joana
    Author
  • Alp, Emine
    Author
  • Koulenti, Despoina
    Author
  • Zhang, Zhongheng
    Author
  • SANEME-2 Investigators
    Collaborator
Show more
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.
Affiliations

Citations

  • APA
  • Chicago
  • FWB

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. (2018). Nebulization of antimicrobial agents in mechanically ventilated adults in 2017: an international cross-sectional survey. Eur J of Clin Micr & Inf Dis : official publication of the European Society of Clinical Microbiology, 37(4), 785-794. https://doi.org/10.1007/s10096-017-3175-5 (Original work published 2018)