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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

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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.

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Acknowledgements

We appreciate comments in the design from Nieves Larrosa, Barcelona, Spain. The study was developed in part from the Observership Programme, ESCMID, Basel, Switzerland (Vandana KE).

Funding

The study was funded in part by Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain, and Observership Programme from ESCMID, Basel, Switzerland.

Author information

Authors and Affiliations

  1. CIBER de Enfermedades Respiratorias, CIBERES, Barcelona, Spain

    Jordi Rello

  2. Vall d’Hebron Institut of Research (VHIR), Barcelona, Spain

    Jordi Rello & Leo Lagunes

  3. Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India

    Vandana Kalwaje Eshwara

  4. Intensive Care, San Luis Potosi, Mexico

    Leo Lagunes

  5. Infectious Diseases, São João Hospital Center, Porto, Portugal

    Joana Alves

  6. Pulmonary & Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Richard G. Wunderink

  7. Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK

    Andrew Conway-Morris

  8. Intensive Care Department, Clinica Santa Fe, Bogota, Colombia

    Jose Nicolas Rojas

  9. Department of Infectious Diseases and Clinical Microbiology, Infection Control Committee, Erciyes University, Kayseri, Turkey

    Emine Alp

  10. Department of emergency medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Zhongheng Zhang

Authors
  1. Jordi Rello
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  2. Vandana Kalwaje Eshwara
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  3. Leo Lagunes
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  4. Joana Alves
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  5. Richard G. Wunderink
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  6. Andrew Conway-Morris
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  7. Jose Nicolas Rojas
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  8. Emine Alp
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  9. Zhongheng Zhang
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Corresponding author

Correspondence to Jordi Rello.

Ethics declarations

Competing interests

Dr. Rello served in the speaker’s bureau or consultant for Pfizer, Anchoagen, ROCHE. The remaining authors have no conflicts of interest to declare.

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Appendices

Appendix 1. TOTEM Study Investigators

Argentina: Luna CM, Reina R; Bulgaria: Dobrevska R, China: Deng H, Leiqing L, Liu L, 温, 沈延飞, LX, Wang D, Yuetian Y, Zhang G, Zh Zhang, Zheng C, YW, ZRYHC; Colombia: Del Rio G; Dominican Republic: Rojas R; Ethiopia: Amare D. France: Alfandri S, Argemi X, Dellamonica J. Kernies S, Lesprit P, Greece: Arvanitik K, Papanikolaou M, Tsigou E, Soultati I, Platsouka E, Katsiari M, Nikolaou C, Tsiodras S; Italy: Antonelli M, Cascio A, DiPascale G, Garofalo E, Girardis M, Leone D; India: Vandana KE, Kaniyarakkal V, Munim F, Nath S, Patil S, Suchitra U; Israel: Yahav D; Kenya: Misango DO; Kosovo:Gecaj-Gashi A; Kuwait: Rotimi V; Mexico: Aguilar D, Araujo-Melendez J, Franco-Zendejas R, Lagunes L, Lemus J, Perales Martinez DE, Rivera Chavez M; Netherlands: Schouten J; Oman: Khamis F; Pakistan: Nizamuddin S, Portugal: Santos L, Santos-Ribeiro E; Romania: Miftode E; South Africa: Alekar S, Baker D, Ballot D, Black V, Bhamjee S, Brannigan L, Hunt IA, Kotze J, Lowman W, Levy B, Mer M, Morar R,Michell W, Nana T, Pahad H, Tsai M, Schleicher GK, Shaddock E, Shoul E, Smith C, Richards GA, Van der Merwe L, Welkovics N; Spain: Borges M, Diaz E, J Garnacho-Montero, Maseda E, Mañez R, Rello J, Samso E, Serrano R, Solvio J, Vidaur L, Zaragoza R; Thailand: Wongsurakiat P; Turkey: Abravci N, Akbudak I, Akkoyunlu Y, Altındiş M, Aydin DÇelebi G, Emel A, Emine A,, Erdem H, Gulden E, Guner R, Kızmaz Y, Yalçin A, Kepenek E, Sener A, Tekin R, Tulek N, Ulu, Unuvar G; United Kingdom: Buckley J, Conway-Morris A, Dunn M, Hall A,Hobrok M, Felton T, Fletcher S, Marshall B, McConnell H, McKee R, McAuley D, McFie C, Morton B, Naisbitt J, Rooney K, Szakmany T, Yates B, Zochios V; Venezuela: Von der Osten J

Appendix 2a- Steering Committee members

Jordi Rello, Spain (Chair); Joana Alves, Portugal; Leonel Lagunes, Mexico; Jeroen Schouten, Netherlands; Celine Pulcini, France; Nieves Larrosa, Spain; Mervyn Mer, South Africa; Emine Alp, Turkey; Zhongheng Zhang, China.

Appendix 2b- Scoring Committee members

Emine Alp, Turkey; Andrew Conway-Morris, UK; Leonel Lagunes, Mexico; Davide Leoni, Italy; Jose Nicolas, Colombia; Jordi Rello, Spain, Vandana KE, India; Richard Wunderink, USA; Zhongheng Zhang, China.

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Rello, J., Kalwaje Eshwara, V., Lagunes, L. et al. A global priority list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care: a prioritization exercise based on multi-criteria decision analysis. Eur J Clin Microbiol Infect Dis 38, 319–323 (2019). https://doi.org/10.1007/s10096-018-3428-y

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