ESCMID Publications

ESCMID Panorama

Guidelines endorsed by ESCMID

PURPOSE:

Diagnosis of spondylodiscitis (SD) may be challenging due to the nonspecific clinical and laboratory findings and the need to perform various diagnostic tests including serologic, imaging, and microbiological examinations. Homogeneous management of SD diagnosis through international, multidisciplinary guidance would improve the sensitivity of diagnosis and lead to better patient outcomePeripheral bone infection (PBI) and prosthetic joint infection (PJI) are two different infectious conditions of the musculoskeletal system. They have in common to be quite challenging to be diagnosed and no clear diagnostic flowchart has been established. Thus, a conjoined initiative on these two topics has been initiated by the European Society of Radiology (ESR), the European Association of Nuclear Medicine (EANM), the European Bone and Joint Infection Society (EBJIS), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The purpose of this work is to provide an overview on the two consensus documents on PBI and PJI that originated by the conjoined work of the ESR, EANM, and EBJIS (with ESCMID endorsement).

METHODS:

An expert specialist team, comprising nuclear medicine physicians appointed by the European Association of Nuclear Medicine (EANM), neuroradiologists appointed by the European Society of Neuroradiology (ESNR), and infectious diseases specialists appointed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), reviewed the literature from January 2006 to December 2015 and proposed 20 consensus statements in answer to clinical questions regarding SD diagnosis. The statements were graded by level of evidence level according to the 2011 Oxford Centre for Evidence-based Medicine criteria and included in this consensus document for the diagnosis of SD in adults. The consensus statements are the result of literature review according to PICO (P:population/patients, I:intervention/indicator, C:comparator/control, O:outcome) criteria. Evidence-based recommendations on the management of adult patients with SD, with particular attention to radiologic and nuclear medicine diagnosis, were proposed after a systematic review of the literature in the areas of nuclear medicine, radiology, infectious diseases, and microbiology.

After literature search, a list of 18 statements for PBI and 25 statements for PJI were drafted in consensus on the most debated diagnostic challenges on these two topics, with emphasis on imaging.

RESULTS:

A diagnostic flow chart was developed based on the 20 consensus statements, scored by level of evidence according to the Oxford Centre for Evidence-based Medicine criteria.

CONCLUSIONS:

This consensus document was developed with a final diagnostic flow chart for SD diagnosis as an aid for professionals in many fields, especially nuclear medicine physicians, radiologists, and orthopaedic and infectious diseases specialists.

 

Link to publication

OBJECTIVES:

For the diagnosis of prosthetic joint infection, real evidence-based guidelines to aid clinicians in choosing the most accurate diagnostic strategy are lacking.

AIM & METHODS:

To address this need, we performed a multidisciplinary systematic review of relevant nuclear medicine, radiological, orthopaedic, infectious, and microbiological literature to define the diagnostic accuracy of each diagnostic technique and to address and provide evidence-based answers on uniform statements for each topic that was found to be important to develop a commonly agreed upon diagnostic flowchart.

RESULTS & CONCLUSIONS:

The approach used to prepare this set of multidisciplinary guidelines was to define statements of interest and follow the procedure indicated by the Oxford Centre for Evidence-based Medicine (OCEBM).

 

Link to publication

OBJECTIVES:

Peripheral bone infection (PBI) and prosthetic joint infection (PJI) are two different infectious conditions of the musculoskeletal system. They have in common to be quite challenging to be diagnosed and no clear diagnostic flowchart has been established. Thus, a conjoined initiative on these two topics has been initiated by the European Society of Radiology (ESR), the European Association of Nuclear Medicine (EANM), the European Bone and Joint Infection Society (EBJIS), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The purpose of this work is to provide an overview on the two consensus documents on PBI and PJI that originated by the conjoined work of the ESR, EANM, and EBJIS (with ESCMID endorsement).

METHODS AND RESULTS:

After literature search, a list of 18 statements for PBI and 25 statements for PJI were drafted in consensus on the most debated diagnostic challenges on these two topics, with emphasis on imaging.

CONCLUSIONS:

Overall, white blood cell scintigraphy and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities for the diagnosis of PBI and PJI. However, the choice of which advanced diagnostic modality to use first depends on several factors, such as the benefit for the patient, local experience of imaging specialists, costs, and availability. Since robust, comparative studies among most tests do not exist, the proposed flowcharts are based not only on existing literature but also on the opinion of multiple experts involved on these topics.

KEY POINTS:

• For peripheral bone infection and prosthetic joint infection, white blood cell and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities. • Two evidence- and expert-based diagnostic flowcharts involving variable combination of laboratory tests, biopsy methods, and radiological and nuclear medicine imaging modalities are proposed by a multi-society expert panel. • Clinical application of these flowcharts depends on several factors, such as the benefit for the patient, local experience, costs, and availability.

 

Link to publication

Although the polymyxins became available in the 1950s, interest in them as salvage therapy for multidrug-resistant and extensively drug-resistant gram-negative infections recently reemerged. However, the lack of standard drug development procedures in the 1950s resulted in significant confusion surrounding their current use.

To address this confusion and provide practitioners with a guide to the optimal clinical use of the polymyxin antibiotics, a diverse, international panel of 18 experts convened over the past 24 months to reach a consensus on therapeutic recommendations.

At the public consultation phase, ESCMID and EUCAST members provided many helpful comments, and ESCMID finally endorsed the consensus document, which provides the first guidance on appropriate investigation and treatment strategies in this patient population, targeting all stakeholders involved in the clinical use of the polymyxin antibiotics, colistin (polymyxin E) and polymyxin B, for the treatment of bacterial infections in adults.

 

Link to publication

11 September 2017

ESCMID endorses the ERS guidelines for the management of adult bronchiectasis

The guideline is the first international guideline discussing the management of adult patients with clinically significant bronchiectasis. Specifically the document aims to provide guidance on the appropriate investigation and treatment strategies in this patient population, targeting all stakeholders involved in bronchiectasis care.

Through the concerted effort of a multidisciplinary group of clinicians under the lead of James D. Chalmers, nine key clinical questions were generated. After conducting a systematic review of the evidence for each question, the quality of evidence was evaluated and the level of recommendation defined. The resulting full text can be accessed through the following page.

Full reference: European Respiratory Society guidelines for the management of adult bronchiectasis. Polverino E, Goeminne PC, McDonnell MJ, Aliberti S, Marshall SE, Loebinger MR, Murris M, Cantón R, Torres A, Dimakou K, De Soyza A, Hill AT, Haworth CS, Vendrell M, Ringshausen FC, Subotic D, Wilson R, Vilaró J, Stallberg B, Welte T, Rohde G, Blasi F, Elborn S, Almagro M, Timothy A, Ruddy T, Tonia T, Rigau D, Chalmers JD. Eur Respir J. 2017 Sep 9;50(3). pii: 1700629. doi: 10.1183/13993003.00629-2017. Print 2017 Sep.  

15 March 2017

Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2016

Crit Care Med. 2017 Mar;45(3):486-552

Intensive Care Med. 2017 Mar;43(3):304-377

ESCMID endorses this guideline.

This guideline came together by the concerted effort of 55 international experts, divided into 5 groups. Each group addressed one of the following topics: hemodynamics, infection, adjunctive therapies, metabolism, and ventilation. The resulting document contains 93 statements on early management and resuscitation of patients with sepsis or septic shock, 32 strong recommendations, 39 weak recommendations and 18 best-practice statements.

Of note, in this version, information on the management of pediatric SSC patients was omitted. This matter will be discussed in a separate publication by the SCCM and the ESICM.

Written by the HIV in Europe initiative that is directed by an independent group of experts which has come together to work for optimal testing and earlier care for HIV in Europe. ESCMID endorses this guidance.

The objectives of the guidance are to:

  • Encourage and support the inclusion of indicator condition-guided HIV testing in national HIV testing strategies, taking into account the local HIV prevalence, ongoing testing programmes and the local healthcare setting;
  • Recommend approaches and practical tools for education and training of healthcare professionals on overcoming barriers to recommending an HIV test.

[Picture © HIV in Europe: HIV Indicator Conditions: Guidance for Implementing HIV Testing in Adults in Health Care Settings]

 

Full text

HIV in Europe initiative website

Guidelines on Prevention, Diagnosis and Treatment of Infective Endocarditis

Gilbert Habib (Chairperson); Bruno Hoen; Pilar Tornos; Franck Thuny; Bernard Prendergast; Isidre Vilacosta; Philippe Moreillon; Manuel de Jesus Antunes; Ulf Thilen; John Lekakis; Maria Lengyel; Ludwig Muller; Christoph K. Naber; Petros Nihoyannopoulos; Anton Moritz; Jose Luis Zamorano, EHJ 2009;30:2369-2413

download

Short statement of the first European consensus conference on the treatement of chronic hepatitis B and C in HIV Co-infected patients

A. Alberti et al., J Hepatol 2005 42: 615-624

download

Crit Care Med. 2013 Feb;41(2):580-637.

ESCMID endorses this guidance.

Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients.

Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008

Dellinger RP, Mitchell ML, Carlet JM et al., Crit Care Med 2008 36: 296-327

download

Do you need funding for guideline production?

Detailed guidance is provided in the ESCMID Operating Procedures for Medical Guidelines.

EOPs for Medical Guidelines