A global priority list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care

a prioritization exercise based on multi-criteria decision analysis

Jordi Rello*, Vandana Kalwaje Eshwara, Leo Lagunes, Joana Alves, Richard G Wunderink, Andrew Conway-Morris, Jose Nicolas Rojas, Emine Alp, Zhongheng Zhang

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The World Health Organization (WHO) proposed a global priority pathogen list (PPL) of multidrug-resistant (MDR) bacteria. Our current objective was to provide global expert ranking of the most serious MDR bacteria present at intensive care units (ICU) that have become a threat in clinical practice. A proposal addressing a PPL for ICU, arising from the WHO Global PPL, was developed. Based on the supporting data, the pathogens were grouped in three priority tiers: critical, high, and medium. A multi-criteria decision analysis (MCDA) was used to identify the priority tiers. After MCDA, mortality, treatability, and cost of therapy were of highest concern (scores of 19/20, 19/20, and 15/20, respectively) while dealing with PPL, followed by healthcare burden and resistance prevalence. Carbapenem-resistant (CR) Acinetobacter baumannii, carbapenemase-expressing Klebsiella pneumoniae (KPC), and MDR Pseudomonas aeruginosa were identified as critical organisms. High-risk organisms were represented by CR Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and extended-spectrum beta-lactamase (ESBL) Enterobacteriaceae. Finally, ESBL Serratia marcescens, vancomycin-resistant Enterococci, and TMP-SMX-resistant Stenotrophomonas maltophilia were identified as medium priority. We conclude that education, investigation, funding, and development of new antimicrobials for ICU organisms should focus on carbapenem-resistant Gram-negative organisms.

Original languageEnglish (US)
Pages (from-to)319-323
Number of pages5
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume38
Issue number2
DOIs
StatePublished - Feb 4 2019

Fingerprint

Carbapenems
Decision Support Techniques
Critical Care
Intensive Care Units
beta-Lactamases
Pseudomonas aeruginosa
Stenotrophomonas maltophilia
Bacteria
Acinetobacter baumannii
Serratia marcescens
Sulfamethoxazole Drug Combination Trimethoprim
Klebsiella pneumoniae
Enterobacteriaceae
Methicillin-Resistant Staphylococcus aureus
Delivery of Health Care
Education
Costs and Cost Analysis
Mortality
Therapeutics

Keywords

  • Antimicrobials
  • Colonization
  • Infection control
  • Intensive care
  • Multidrug-resistant bacteria
  • Prevention
  • Research
  • Sepsis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Rello, Jordi ; Kalwaje Eshwara, Vandana ; Lagunes, Leo ; Alves, Joana ; Wunderink, Richard G ; Conway-Morris, Andrew ; Rojas, Jose Nicolas ; Alp, Emine ; Zhang, Zhongheng. / A global priority list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care : a prioritization exercise based on multi-criteria decision analysis. In: European Journal of Clinical Microbiology and Infectious Diseases. 2019 ; Vol. 38, No. 2. pp. 319-323.
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A global priority list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care : a prioritization exercise based on multi-criteria decision analysis. / Rello, Jordi; Kalwaje Eshwara, Vandana; Lagunes, Leo; Alves, Joana; Wunderink, Richard G; Conway-Morris, Andrew; Rojas, Jose Nicolas; Alp, Emine; Zhang, Zhongheng.

In: European Journal of Clinical Microbiology and Infectious Diseases, Vol. 38, No. 2, 04.02.2019, p. 319-323.

Research output: Contribution to journalArticle

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AU - Alp, Emine

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