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A nationwide survey on involvement of clinical microbiologists in antibiotic stewardship programmes in large French hospitals

  • Marion Le MaréchalEmail author
  • Nelly Agrinier
  • Vincent Cattoir
  • Céline Pulcini
  • on behalf of the ABS-CM working group
Original Article

Abstract

Antibiotic stewardship programmes (ASP) are essential to tackle antibiotic resistance. Clinical microbiologists (CMs) play a key role in these programmes; however, few studies describe their actual involvement. Our objective was to explore CMs’ involvement in French hospital ASP. In 2018, we conducted a survey among CMs working in large public French hospitals (600 acute care beds or more). The questionnaire focused on the following topics: microbiology department’s characteristics, hospital ASP, and CMs’ involvement in this programme, including their use of rapid diagnostic tests (RDT). Fifty/74 CMs answered (response rate 68%), with 68% working in a teaching hospital. CMs were leading the ASP in 6% of cases, and 57% of hospitals had a multidisciplinary antibiotic stewardship team. Most microbiology departments (92%) were using specific PCR, processed 24/7 in 74% of hospitals. More than half (58%) were using syndromic panel-based testing, 94% mass spectrometry, and 96% immunochromatographic/colorimetric RDT. Blood cultures were processed 24/7 in 44% of hospitals. CMs were involved in this. Finally, 42% of CMs wished to be more involved in their hospital’s ASP, the most frequently reported barrier being lack of time (36%). CMs should be more involved in ASP. RDT are widely used, but not implemented in an optimal way.

Keywords

Antimicrobial stewardship Microbiologist Rapid diagnostic test 

Notes

Acknowledgments

Three CMs that pilot tested the questionnaire:

Gabriel Auger (CHU de Rennes), Nicolas Degand (CHU de Nice) and Caroline Piau (CHU de Rennes).

Members of the ABS-CM group

Olivier Belmonte (Laboratoire de Bactériologie, CHU Réunion), Béatrice Bercot (Département de microbiologie, Unité de Bactériologie, Hôpital Saint-Louis, AP-HP), Anne Cady (Laboratoire de biologie médicale, CH de Vannes), Jocelyne Caillon (Laboratoire de Bactériologie, CHU de Nantes), Christian Cattoen (Centre Hospitalier de Valenciennes), Julie Cremniter (Service de Bactériologie, CHU de Poitiers), Olivier Dauwalder (Centre de Biologie et Pathologie Nord, Plateau de Microbiologie 24/24, Hôpital de la Croix-Rousse, CHU de Lyon), Dominique André De Briel (Fédération des laboratoires, HIA de Bégin), Laurent Dortet (Laboratoire de Bactériologie-Hygiène, Hôpital de Bicêtre, AP-HP), Anabèle Dos Santos (Service de Maladies Infectieuses et Tropicales, CH de Niort), Florence Doucet-Populaire (Hôpital Antoine Béclère, AP-HP), Véronique Dubois (Service de bactériologie, Hôpital Pellegrin, CHU de Bordeaux), Clarisse Dupin (CH Saint-Brieuc), Agnès Ferroni (Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, AP-HP), Jenny Gallou (Laboratoire de bactériologie, CH Aix-en-Provence), Pauline Garnier (Laboratoire de Biologie médicale, Hôpital Nord Franche Comté), Thomas Guillard (Laboratoire de Bactériologie-Virologie-Hygiène-Parasitologie-Mycologie, Hôpital Robert Debré, CHU de Reims), Jean-Louis Herrmann (Service de microbiologie, Hôpital Raymond Poincaré, AP-HP), Christophe Isnard (Service de microbiologie, CHU de Caen), Hervé Jacquier (Service de Bactériologie-Virologie, Hôpital Lariboisière, AP-HP), Françoise Jaureguy (Hôpital Avicenne, AP-HP), Marie Kempf (Service de Bactériologie-Hygiène, CHU d’Angers), Luce Landraud (Service de Microbiologie et Hygiène, Hôpital Louis Mourier, AP-HP), Jean-Philippe Lavigne (Service de Microbiologie, CHU de Nîmes), Cécile Le Brun (CHU Tours), Florian Lorme (Pôle Médico-Technique et Fonctions Transversales, Centre Hospitalier Sud-Francilien), Alain Lozniewski (Service de microbiologie, CHRU de Nancy).

Jean-Luc Mainardi (Service de microbiologie, HEGP, AP-HP), Marie-Cécile Ploy (Laboratoire de Bactériologie-Virologie-Hygiène, CHU de Limoges), Isabelle Podglajen (Service de microbiologie, HEGP, AP-HP), Charlotte Pujol (Service de bactériologie, CH de Perpignan), Jérôme Robert (Bactériologie-Hygiène hospitalière, Hôpitaux Pitié Salpétrière-Charles Foix, AP-HP), Anne-Laure Roux (Service de Microbiologie, Hôpital Ambroise Paré, AP-HP), Raymond Ruimy (Service de bactériologie, CHU de Nice), Frédéric Schramm (Laboratoire de Bactériologie, CHU de Strasbourg), Simon Sunder (Service de Maladies Infectieuses et Tropicales, CH de Niort), Didier Tandé (Laboratoire de Bactériologie-Virologie, CHRU deBrest), Anne Vachée (Laboratoire, CH de Roubaix), Fréderic Wallet (Institut de Microbiologie-Service de Bactériologie, CHRU de Lille).

Author contribution

C. P. initiated the study. M. L. M., N. A., V. C. and C. P. contributed to the study design. M. L. M., V. C. and C. P. contributed to the implementation and supervision of the study. M. L. M. analysed the data and takes responsibility for the accuracy of the data analysis. M. L. M. and C. P. drafted the manuscript. All authors read and approved the final manuscript.

Funding

The study was carried out as part of our routine work.

Compliance with ethical standards

In accordance with French laws, this survey did not need any ethical approval. Participation in the survey was voluntary, anonymous and without any financial compensation.

Conflict of interest

The authors declare that they have no conflict of interest. Each author has fulfilled the Conflict of Interest Disclosure Form.

Supplementary material

10096_2019_3665_MOESM1_ESM.pdf (63 kb)
ESM 1 (PDF 63 kb)

References

  1. 1.
    Dyar OJ, Tebano G, Pulcini C, ESGAP (ESCMID Study Group for Antimicrobial stewardshiP) (2017) Managing responsible antimicrobial use: perspectives across the healthcare system. Clin Microbiol Infect 23:441–447CrossRefGoogle Scholar
  2. 2.
    Pulcini C, Huttner A (2018) CMI policy on antimicrobial stewardship research. Clin Microbiol Infect 24:91–92CrossRefGoogle Scholar
  3. 3.
    EU Guidelines for the prudent use of antimicrobials in human health [Internet]. European Centre for Disease Prevention and Control (ECDC); 2017. https://ec.europa.eu/health/amr/sites/amr/files/amr_guidelines_prudent_use_en.pdf. Accessed 28 July 2019
  4. 4.
    Morency-Potvin P, Schwartz DN, Weinstein RA (2017) Antimicrobial stewardship: how the microbiology laboratory can right the ship. Clin Microbiol Rev 30:381–407PubMedGoogle Scholar
  5. 5.
    Pulcini C (2017) Antibiotic stewardship: a European perspective. FEMS Microbiol Lett 15:364Google Scholar
  6. 6.
    Perez KK, Olsen RJ, Musick WL, Cernoch PL, Davis JR, Land GA et al (2013) Integrating rapid pathogen identification and antimicrobial stewardship significantly decreases hospital costs. Arch Pathol Lab Med 137:1247–1254CrossRefGoogle Scholar
  7. 7.
    Box MJ, Sullivan EL, Ortwine KN, Parmenter MA, Quigley MM, Aguilar-Higgins LM et al (2015) Outcomes of rapid identification for gram-positive bacteremia in combination with antibiotic stewardship at a community-based hospital system. Pharmacotherapy 35:269–276CrossRefGoogle Scholar
  8. 8.
    Timbrook TT, Morton JB, McConeghy KW, Caffrey AR, Mylonakis E, LaPlante KL (2017) The effect of molecular rapid diagnostic testing on clinical outcomes in bloodstream infections: a systematic review and meta-analysis. Clin Infect Dis 64(1):15–23CrossRefGoogle Scholar
  9. 9.
    Bauer KA, Perez KK, Forrest GN, Goff DA (2014) Review of rapid diagnostic tests used by antimicrobial stewardship programs. Clin Infect Dis 59(Suppl 3):S134–S145CrossRefGoogle Scholar
  10. 10.
    MacKenzie FM, Gould IM, Bruce J, Mollison J, Monnet DL, Krcmery V et al (2007) The role of microbiology and pharmacy departments in the stewardship of antibiotic prescribing in European hospitals. J Hosp Infect 65(Suppl 2):73–81CrossRefGoogle Scholar
  11. 11.
    Bailey C, Tully M, Cooke J (2015) Perspectives of clinical microbiologists on antimicrobial stewardship programmes within NHS trusts in England. Antimicrob Resist Infect Control 4:47CrossRefGoogle Scholar
  12. 12.
    Décret n° 2013–841 du 20 septembre 2013 modifiant les dispositions relatives à la commission médicale d’établissement et aux transformations des établissements publics de santé et à la politique du médicament dans les établissements de santé [Internet]. Légifrance; 2013. doi: https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000027979376&dateTexte=&categorieLien=id. Accessed 28 July 2019
  13. 13.
    Instruction DGS/RI1/DGOS/PF2/DGCS no 2015–212 du 19 juin 2015 relative à la mise en œuvre de la lutte contre l’antibiorésistance sous la responsabilité des agences régionales de santé [Internet]. Ministère des affaires sociales, de la santé et des droits des femmes; 2015. doi: https://solidarites-sante.gouv.fr/IMG/pdf/instruction_19062015.pdf. Accessed 28 July 2019
  14. 14.
    Fiche descriptive 2018. Thème infections Associées aux Soins (IAS) ICATB.2 [internet]. Haute Autorité de Santé (HAS); 2018. doi: https://www.has-sante.fr/portail/upload/docs/application/pdf/2016-04/2016_has_fiche_descriptive_icatb_2.pdf. Accessed 28 July 2019
  15. 15.
    Annuaire [Internet]. Fédération Hospitalière de France; doi: https://etablissements.fhf.fr/annuaire/recherche-hopital.php. Accessed 28 July 2019
  16. 16.
    Kallen MC, Ten Oever J, Prins JM, Kullberg BJ, Schouten JA, Hulscher MEJL (2018) A survey on antimicrobial stewardship prerequisites, objectives and improvement strategies: systematic development and nationwide assessment in Dutch acute care hospitals. J Antimicrob Chemother 73:3496–3504CrossRefGoogle Scholar
  17. 17.
    Sinha M, Jupe J, Mack H, Coleman TP, Lawrence SM, Fraley SI. Emerging Technologies for Molecular Diagnosis of sepsis. Clin Microbiol Rev 2018;31. doi:  https://doi.org/10.1128/CMR.00089-17
  18. 18.
    Perozziello A, Routelous C, Charani E, Truel A, Birgand G, Yazdanpanah Y et al (2018) Experiences and perspectives of implementing antimicrobial stewardship in five French hospitals: a qualitative study. Int J Antimicrob Agents 51:829–835CrossRefGoogle Scholar
  19. 19.
    Diallo K, Thilly N, Luc A, Beraud G, Ergonul Ö, Giannella M et al (2018) Management of bloodstream infections by infection specialists: an international ESCMID cross-sectional survey. Int J Antimicrob Agents 51:794–798CrossRefGoogle Scholar
  20. 20.
    Eveillard M, Lemarié C, Cottin J, Hitoto H, Mahaza C, Kempf M et al (2010) Assessment of the usefulness of performing bacterial identification and antimicrobial susceptibility testing 24 h a day in a clinical microbiology laboratory. Clin Microbiol Infect 16:1084–1089CrossRefGoogle Scholar
  21. 21.
    Skodvin B, Aase K, Brekken AL, Charani E, Lindemann PC, Smith I (2017) Addressing the key communication barriers between microbiology laboratories and clinical units: a qualitative study. J Antimicrob Chemother 72:2666–2672.  https://doi.org/10.1093/jac/dkx163 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Coupat C, Pradier C, Degand N, Hofliger P, Pulcini C (2013) Selective reporting of antibiotic susceptibility data improves the appropriateness of intended antibiotic prescriptions in urinary tract infections: a case-vignette randomised study. Eur J Clin Microbiol Infect Dis 32:627–636CrossRefGoogle Scholar
  23. 23.
    Pulcini C, Tebano G, Mutters NT, Tacconelli E, Cambau E, Kahlmeter G et al (2017) Selective reporting of antibiotic susceptibility test results in European countries: an ESCMID cross-sectional survey. Int J Antimicrob Agents 49:162–166CrossRefGoogle Scholar
  24. 24.
    Comité de l’antibiogramme de la Société Française de Microbiologie [Internet]. European committee on antibiogram susceptibility testing (EUCAST); 2019. doi: https://www.sfm-microbiologie.org/wp-content/uploads/2019/01/CASFM2019_V1.0.pdf. Accessed 04 Aug 2019

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Département de Santé PubliqueHôpital l’Archet, CHU de NiceNiceFrance
  2. 2.Université de Lorraine, EA 4360 APEMACNancyFrance
  3. 3.Université de Lorraine, CHRU-Nancy, INSERM, CIC-1433, Epidémiologie CliniqueNancyFrance
  4. 4.CHU de Rennes, Service de Bactériologie-Hygiène hospitalière & CNR de la Résistance aux Antibiotiques (laboratoire associé ‘Entérocoques’)RennesFrance
  5. 5.Faculté de Médecine & Unité Inserm U1230Université de Rennes 1RennesFrance
  6. 6.Infectious Diseases DepartmentUniversité de Lorraine, CHRU-NancyNancyFrance

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