Antimicrobial optimisation

About

Infections in the healthcare setting are common and cause too many people to die. Severe infections commonly occur in patients with critical illness, burns, transplant, cystic fibrosis and immunosuppression. Infections in these patients are more difficult to treat leading to more multi-drug resistant (‘superbug’) infections which are associated with increased mortality and poorer health outcomes.

The Antimicrobial Optimisation Group is addressing these issues by improving antimicrobial dosing in these challenging special patient populations, using our world leading collaborative experience in the areas of laboratory-based infection and experimental models, clinical pharmacokinetics, pharmacometrics and clinical trials to define robust and evidence-based dosing regimens of our most commonly used antibiotics that will maximise antimicrobial effectiveness including reducing the emergence of resistance.

Contact

+61 7 3346 5020

s.athanasas@uq.edu.au

Critically ill patients often have varying physiological needs to an average patient and often require different dosages of antibiotics and other drugs, particularly if they are on renal replacement therapies. There is also a controversy over whether bolus dosing or continuous infusion of β-lactams is more effective in antibiotic delivery in critically ill patients. Professor Lipman has pioneered work that demonstrates that patients in intensive care are not receiving enough antibiotics to achieve optimal levels to kill pathogens. This in turn leads to poorer health outcomes for patients and antibiotic resistance. Antibiotic resistant infections commonly occur in long stay, debilitated patients and contribute to increased risk of death, longer ICU and hospital stay, further weakness and long term dysfunction. This problem also contributes to patients being unable to be discharged from ICU or hospital and so exacerbating the shortage of acute hospital beds and increases in surgery waiting time.

Current projects

  • Creatinine clearance of critically ill Australian indigenous patients – a longitudinal study (CROC Study). Tsai D, Udy A, Stewart P, Gourley S, Morick N, Lipman J, Roberts J. Funder: NHMRC Postgraduate Scholarship
  • Non-Haemolytic Friulimicins for the Treatment of Multi-Drug Resistant Bacteria. Cooper M, Roberts J, Butler M. Funder: NHMRC
  • Pharmacokinetics of Enteric Coated Mycophenolate Sodium in Lupus Nephritis (POEMSLUN). Ranganathan D, Roberts J, John G, Fassett R, Healy H, Lipman J, Kubler P, Ungerer J. Funder: RBWH
  • Epidemiology of Pneumonia in the Central Australian Intensive Care Unit. Tsai D, Goud R, Hewagama S, Stewart P, Hnin K-M, Tin K-S, Sun H, Roberts J. Funder: NHMRC Postgraduate Scholarship (D Tsai); Australian Academy of Science (D Tsai).
  • Pharmacokinetics of broad spectrum antibiotics in extracorporeal membrane oxygenation (ECMO) - using plasma concentrations to optimize antibiotic therapy. Welch S, Roberts J, Burrows F, Levkovich B, Ray J, Pellegrino V, Bui T, Wallis S, Marriott D, Rudham S. Funder: Society of Hospital Pharmacists of Australia (SHPA), RBWH Foundation
  • Antibiotic, sedative and analgesic drug pharmacokinetics during ovine extracorporeal membrane oxygenation - understanding altered pharmacokinetics to improve patient outcomes. Shekar K, Roberts J, Smith M, Fung Y, Fraser J, Wallis S, Mullany D, Diab S, McDonald C, Barnet A, Ghassabian S, Platts D, Dunster K. Funder: ANZCA, TPCH Foundation, ANZICS
  • The Pharmacokinetics of Vancomycin and Ticarcillin-Clavulanate in Critically Ill Patients undergoing Sustained Low-Efficiency Dialysis (SLED). Economu C. Funder RBWH Scholarship
  • Ketorolac pharmacokinetics in joint replacements. Roberts J, Wallis S, Gurunathan U.
  • Sampling Antibiotics in Renal Replacement Therapy (SMARRT Study).  Roberts J,  Lipman J, Roberts M, Paul S, Peake S, Turnidge J, Joynt G, Lee A, Gomersall C, Choi G. Funder: NHMRC; Chinese University of Hong Kong
  • Does inhaled antibiotics deliver optimal concentrations to the lung to improve treatment of pneumonia. An animal in vivo study using the microdialysis technique. Dhanani J, Paterson D, Roberts J, Chew M, Fraser J. Funder: RBWH
  • Dosing to maximise bacterial killing and prevent resistance in ICU. Roberts J, Lipman J, Wallis S,  Kirkpatrick C, Landersdorfer C, Bulitta J, Bergen P. Funder: NHMRC
  • Piperacillin and cefazolin pharmacokinetics in sepsis and trauma. Roberts J, Lipman J, Udy A, Wallis S, Kirkpatrick C, Kruger P, Roberts M.
  • PARITY: Paracetamol in Traumatic Brain Injury. Principal Investigator: Gowardman J, Roberts J, Lipman J, Wallis S, Saxena M.
  • Continuous vs bolus cefazolin in abdominal surgery patients (collaboration with University of Virginia). Roberts J, Lipman J, Wallis S, Naik B, Ikeda K, Todorovic M.
  • Antibiotic pharmacokinetic study in renal replacement therapy - CVVHF vs CVVHDF (collaboration with CHU Nimes). Roberts J, Lipman J, Wallis S, Lefrant J-Y, Roger C, Muller L. Funder: Le Centre Hospitalier Universitaire de Nimes (CHU Nimes)
  • Antibiotic pharmacokinetics in Slow Low Efficiency Dialysis (piperacillin, meropenem and vancomycin; collaboration with The Ottawa Hospital). Roberts J, Kanji S, Zelenitsky S.
  • Teiciplanin pharmacokinetics and protein binding in methicillin resistant S. aureus infection (collaboration with Trinity College Ireland). Roberts J, D'Arcy D, Byrne C.
  • CAMERA: Combination antibiotic treatment for Methicillin Resistant Staphylococcus Aureus Bacteraemia – an RCT. Davis J, Tong S, Paterson D, Fowler V, Howden B, Cheng A, Chatfield M, Lipman J, van Hal S, O’Sullivan M. Funder: NHMRC
  • Validation of Microsampling Versus Traditional Blood Sampling For Antibiotic Pharmacokinetics. Chikatamarla A, Parker S, Wallis S, Lipman J, Presneill J, Roberts J, Dorofaeff T, Jarrett P. Funder: RBWH Foundation; AHEPA
  • Pharmacokinetics of Antibiotics in the critically unwell children. Dorofaeff T. Funder: AHEPA
  • Population pharmacokinetics of meropenem in critically ill patients and development of dosing software (Collaboration with University of Liverpool). Roberts J, Hope W, Belen A.
  • Meropenem and ciprofloxacin pharmacokinetics in ICU patients with shock (MaC-DIPPS). Roberts J, Lipman J, Sjovall F, Christrup L, Kreilgaard M, Perner A, Frimodt-Møller N.
  • Plasma and tissue pharmacokinetics of lincomycin in patients with burn wound infection. Muller M, Wang L, Roberts J, Lipman J. Funder: RBWH Foundation
  • An Investigation of the Pharmacokinetics of Pip/taz, Meropenem and Fluconazole in Critically Ill Obese Patients (PHANCO). Alobaid A, Roberts J, Lipman J, Roberts M. Funder: Saudi Arabian Cultural Mission
  • Incidence, Risk Factors, Consequences and Treatment of Ventilated Patients with Nosocomial Infection with Pandrug Resistant Organisms in Hospitals in Asia. McGloughlin S, Webb S, Lipman J, Paterson D, Roberts J, Phau J. Funder: ICF; University of Western Australia – UQ Collaboration
  • Pharmacokinetic Australasian Collaborative. Lipman J, Roberts J, Joynt G, Udy A, Nicholas M. Funder: ICF
  • Optimising benzylpenicillin dosing for critically ill patients with severe pneumonia. Roberts J, Cotta O, Boots R. Funder: RBWH Foundation
  • A Phases III Randomized Controlled Trial of Continuous β-lactam Infusion Compared with Intermittent β-lactam Dosing in Critically ill patients. Dulhunty J, Starr T, Lipman J. Funder: RBWH Foundation
  • Levetiracetam pharmacokinetics in critically ill patients with severe traumatic brain injury and subarachnoid hemorrhage. Cotta O, Roberts J, Presneill J. Funder: ICF, RBWH Foundation
  • Optimising ceftriaxone dosing for critically ill patients with severe pneumonia. Roberts J, Cotta O, Boots R. Funder: RBWH Foundation
  • Improving piperacillin/tazobactam dosing in critically ill Australian Indigenous patients with severe sepsis. Tsai D, Stewart P, Goud R, Gourley S, Hewagama S, Krishnaswamy S, Wallis S, Lipman J, Roberts J. Funder: NHMRC Postgraduate Scholarship (D Tsai); Australian Academy of Science (D Tsai)
  • Improving meropenem dosing in critically ill Australian Indigenous patients with severe sepsis. Tsai D, Stewart P, Goud R, Gourley S, Hewagama S, Krishnaswamy S, Wallis S, Lipman J, Roberts J. Funder: NHMRC Postgraduate Scholarship (D Tsai); Australian Academy of Science (D Tsai)
  • Improving vancomycin dosing in critically ill Australian Indigenous patients with severe sepsis. Tsai D, Stewart P, Goud R, Gourley S, Hewagama S, Krishnaswamy S, Wallis S, Lipman J, Roberts J. Funder: NHMRC Postgraduate Scholarship (D Tsai); Australian Academy of Science (D Tsai)
  • Improving ceftriaxone dosing in critically ill Australian Indigenous patients with severe sepsis.
  • Tsai D, Stewart P, Goud R, Gourley S, Hewagama S, Krishnaswamy S, Wallis S, Lipman J, Roberts J. Funder: NHMRC Postgraduate Scholarship (D Tsai); Australian Academy of Science (D Tsai)
  • Residual antibiotics post reconstitution: REPORT Study. Jarrett P, Coyer F, Cook J, Wallis S, Cotta O, Cohen J. 

Clinical trials

ASAP-ECMO (Extracorporeal Membrane Oxygenation): A multi-centre Australian pharmacokinetic study evaluating the pharmacokinetics of various antibiotics, antifungals, sedatives and analgesics in critically ill patients receiving extracorporeal membrane oxygenation. Principal Site Investigator: J Roberts

BLING III: A phase III randomised controlled trial of continuous beta-lactam infusion compared with intermittent beta-lactam dosing in critically ill patients. Principal Site Investigator: J Lipman

Ceftolozane/Tazobactam RRT: An observational pharmacokinetic study of Ceftolozane-Tazobactam in Intensive Care Unit in patients with and without continuous renal replacement therapy. Principal Site Investigator: J Roberts

Ceftolozane/Tazobactam EVD: A prospective observational pharmacokinetic evaluation of the plasma and cerebrospinal fluid concentrations of a single dose ceftolozane/tazobactam in infected critically ill patients with an indwelling external ventricular drain. Principal Site Investigators: J Roberts, J Lipman

Colonic Flora: Assessing the effects of antibiotic choice on gut microbiota of ICU patients - a metagenomic approach. Principal Site Investigators: D Paterson, P Harris, S Schlebusch

Microsampling: Validation of microsampling versus traditional blood sampling for antibiotic pharmacokinetics. Principal Site Investigators: J Lipman, S Wallis

OASES: The Pharmacokinetics of Ceftriaxone, Meropenem, Piperacillin-Tazobactam and Vancomycin in the Cerebrospinal Fluid of Critically Ill Patients with Uninflamed Meninges. Principal Site Investigators: J Roberts, N Kumta

RESIST: Recognising Sepsis in SIRS Trial. Principal Site Investigator: K Denny

Research support

  • Tertiary Intensive Care Unit - all pathology and radiological investigations available
  • Tertiary Burns Unit - all pathology and radiological investigations available
  • Skin Culture Facility
  • Fully equipped bioanalytical laboratory with HPLC & LCMS capabilities
  • Hollow fibre infection model -  a state- of- the art dynamic in vitro infection model for pharmacokinetic/pharmacodynamic profiling of antibiotics 
  • Screening antibacterial activity with static-concentration time-kill kinetics and susceptibility assays

Resources

  • Epidemiological support
  • Statistical advice
  • Expert postgraduate supervision
  • Data mining

Queensland

University of Queensland:

Prof David Paterson, Casey Pfluger, Hosam Zowawi, University of Queensland Centre for Clinical Research

Prof Alastair McEwan, Prof Michael Jennings, A/Prof Mark Schembri , A/Prof Scott Beatson, Molecular & Microbial Sciences

Dr Ian Shiels, Prof Stephen Taylor, Dr Trent Woodruff, Department of Physiology & Pharmacology

Prof Michael Roberts, Dr Greg Medley, Dr Sheree Cross, Dr Thomas Robertson, Therapeutics Research Unit

Queensland Health Pathology Service: A/Prof Graham Nimmo

Griffith University: Prof Claire Rickard, Dr Li Zhang, School of Nursing & Midwifery

Princess Alexandra Hospital: Dr Peter Kruger, Prof Bala Venkatesh, Dr Geoff Playford, Dr Rob Eley, ICU

The Prince Charles Hospital: Prof John Fraser, A/Prof Kiran Shekar

Royal Brisbane and Women’s Hospital:

Dr Jacobus Ungerer, Dr John Cardinal, Dr Carel Pretorius, Dr Brett McWhinney, Chemical Pathology

A/Prof Mark Coulthard, Paediatrics and Child Health

Dr Helen Healy, Dr Adrian Kark, Dr Dwarka Ranganathan, Prof Rob Fassett, Dr Vincent D'Intini, Renal Medicine

Dr Kerina Denny

Dr Joel Dulhunty

Redcliffe Hospital: Dr Alexis Tabah, Dr Tim Warhurst

Queensland University of Technology: Prof Lyn Griffiths, Dr Larisa Haupt,

QIMR Berghofer Medical Research Institute: Dr David McMillan, Bacterial Pathogenesis Laboratory

Toowoomba Hospital: Dr Indranil Chatterjee

National

Westmead Hospital, Sydney:

A/Prof Jon Iredell, Prof Tania Sorrell, Dr Heather Giddings, Dr Catriona Halliday, Dr John Gallagher, Dr Vineet Nayyar

The Alfred Hospital, Melbourne:

A/Prof David Tuxen, A/Prof Carlos Scheinkestel, Dr Andrew Davies, A/Prof Denis Spelman, Dr Alex Padiglione, A/Prof Anne Holland, Dr Carol Hodgson, Prof Russell Gruen, National Trauma Research Institute

Austin & Repatriation Hospital, Melbourne:

Prof Rinaldo Bellomo, Dr Sue Berney, Prof Lindsay Grayson, Dr Barrie Mayall, Dr Glenn Eastwood

The George Institute for International Health, Sydney:

Prof John Myburgh, Prof Simon Finfer, Dr Manoj Saxena

Menzies School of Health Research, Darwin: Dr Joshua Davis

Royal Perth Hospital:

Prof Steve Webb, Dr Geoff Dobb, Dr Paul Ingram, Dr KM Ho, Dr Andrew Heard, Dr Richard Riley, Dr Matt Rawlins

St Vincent’s Hospital, Sydney: A/Prof Debbie Marriott, Dr Sam Rudham

Notre Dame University, Perth: Dr Shane Patman

Royal Darwin Hospital, NT: Dr Dianne Stephens

Royal Hobart Hospital, TAS: Dr David Cooper

Canberra Hospital, ACT:

Dr Frank van Haren, Ms Margot Green, Dr Marta Kot

Monash Medical Centre, Melbourne: Elizabeth Skinner

Royal Melbourne Hospital: Dr Reny Segal

Monash University:

Prof Carl Kirkpatrick, Pharmacy & Pharmaceutical Sciences

Dr Carol Hodgson, Public Health & Preventive Medicine

Dr Cornelia Landersdorfer, Centre for Medicine Use & Safety 

Dr Philip Bergen, Centre for Medicine Use & Safety

Prof Steve Webb, Dr Carol Hodgson, Ms Lorraine Little, Prof Alistair Nichol, Mr Tony Trapani, ANZIC Research Centre

Prof Jamie Cooper, Prof Rinaldo Bellomo, Ms Lynne Murray, Prof Kim Bennell, Prof Janet McCalman, Prof Linda Denehy, A/Prof Sue Berney, Prof S Paul

Royal Adelaide Hospital: Dr Chris Acott

La Trobe University, Melbourne: Prof Nick Taylor

Royal North Shore Hospital, Sydney: Dr George Kotsiou

Biodevices International Pty Ltd., Victoria: Dr David Noble

Australian Red Cross Blood Service, NSW:

Dr David Irving, Dr Denese Marks, Research and Development

St Vincent’s Hospital, Melbourne: Dr Barry Dixon

Blacktown Hospital, NSW: Dr Charudatt Shirwadkar

Lyell McEwin Hospital, Adelaide: Dr Milind Sanap, Dr Peter Thomas

Flinders Medical Centre, Adelaide: Dr David Durham

Sir Charles Gairdner Hospital, Perth: Dr Stuart Baker, A/Prof David Mountain

Bendigo Hospital Bendigo, Victoria: Dr Jason Fletcher

Bendigo Hospital Bendigo, Victoria

Geelong Hospital, Victoria: Dr Neil Orford, Dr Claire Cattigan

Gosford Hospital: Dr Rob Cameron

Royal Prince Alfred Hospital: Dr David Gattas

St George Hospital, Sydney: Dr Andrew Cheung

Wollongong Hospital: Dr Martin Sterba

ANZICS Clinical Trials Group: A/Prof Sandra Peake

The University of Western Australia:

Prof Antonio Celenza, A/Prof Tim Inglis, Prof Simon Brown, Prof Michael Paech

Australian National University & Canberra Hospital: Dr Anne Leditschke

King Edward Memorial Hospital: Prof Michael Paech

International

Chinese University of Hong Kong: Prof Charles Gomersall, Prof Gavin Joynt, Dr Gordon Choi, Anaesthesia & Intensive Care

The University of Hong Kong: Prof Michael Irwin, Department of Anaesthesiology

University College London, UK: Prof Mervyn Singer, Dr Alberto Corona, Bloomsbury Institute of Intensive Care Medicine

Tübingen University Hospital, Germany: Prof Wolfgang Krueger, Department of Anesthesiology and  Intensive Care Medicine

Changi General Hospital, Singapore: Dr Noelle Lim, Dept of Anaesthesia & Surgical Intensive Care

Hospital Vall d'Hebron, Spain: Prof Jordi Rello, Dr Elsa Afonso, Dr Laura Ruano, Critical Care Department

University of Witwatersrand, South Africa: Prof Satish Bhagwanjee, Ms Juan Scribante, Dept of Anaesthesia

Institute of Pharmacological Research, Italy: Dr Guido Bertolini, Laboratory of Clinical Epidemiology

University College London, UK: Dr A Peter Wilson, Department of Microbiology,

University of Otago, New Zealand: Dr Martin Than, Department of Emergency Medicine

Queen Elizabeth Hospital, Birmingham, United Kingdom: Prof Tony Whitehouse

Hospital Macarena Seville, Spain: Prof Jesus Rodriguez-Bano

John Hopkins University, USA: Prof Dale Needham

University of Florida: Dr Jürgen Bulitta, College of Pharmacy

University of Michigan, USA: Prof Jack Iwashyna

University of Dublin, Ireland: Prof Ignacio Martin-Loaches

National University of Ireland: Prof Alistair Nichol

Washington University, Missouri, USA: Prof M Kollef

Ordway Research Institute, New York, USA: Prof George Drusano

Baragwanath Hospital, South Africa: Dr Shahed Omar

Wellington Regional Hospital Wellington, New Zealand: Dr Dick Dinsdale, Dr Paul Young

Auckland City Hospital, New Zealand: Dr Colin McArthur, Dr Shay McGuinness

Canterbury District Health Board, New Zealand: Dr Seton Henderson

Middlemore Hospital, New Zealand: Dr Alex Kazemi

Hawkes Bay Hospital, New Zealand: Dr Ross Freebairn

University of Auckland, New Zealand: Prof Alan Merry

Waikato Clinical School of Medicine, New Zealand: Prof Jamie Sleigh, Dr Rob Frengley

University of Limpopo, South Africa: Prof Andries Gous, School of Pharmacy

Wellington Regional Hospital and Medical Research Institute of New Zealand, Wellington: Dr Paul Young

Washington Hospital Center, USA: A/Prof Andrew Shorr

Coimbra University Hospitals, Portugal: Dr Joao Pedro Baptista

Thomas Jefferson University, Philadelphia, USA: Prof Paul Marik, Pulmonary and Critical Care Medicine,

St George’s Healthcare NHS Trust and St George’s University of London, London, England: Dr Andrew Rhodes

Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia: Dr Mohd Zulfakar Mazlan

Hospital Tengku Ampuan Afzan, Kuantan, Malaysia: Dr Janattul Ain Jamal

International Islamic University Malaysia, Kuantan, Malaysia: A/Prof Mohd Basri Mat Nor

University of Malaya Medical Centre, Kuala Lumpur, Malaysia: A/Prof Mohd Shahnaz Hasan, Dr Helmi Sulaiman

Attikon University Hospital, Athens, Greece: Prof George Dimopoulos, Prof Apostolos Armaganidis         

Hacettepe University Hospital, Turkey: Dr Murat Akova, Dr Arife Özveren

Ospedale, San Martino, Genova, Italy: Prof Matteo Bassetti

Centre Hospitalier Universitaire Bichat-Claude Bernard, AP-HP, Université Paris VII, Paris, France: Prof Philippe Montravers

Hospital Nord, Marseille; AzuRea Group, France: Dr Claude Martin

Ghent University Hospital, Ghent, Belgium: Prof Jan de Waele, Prof Stijn Blot, Dr Luc De Crop

Royal Centre for Defence Medicine, Birmingham, UK: Colonel Rob Russell

University of Pittsburgh, USA: Prof Derek Angus

UK Intensive Care National Audit and Research Centre, London, England: Prof Kathy Rowan

US Army Institute of Surgical Research: Colonel Jeff Bailey, Colonel Todd Rasmussen

NATO Role 3 Hospital, Kandahar, Afghanistan: Lieutenant Commander Travis Polk, US Navy

Beth Israel Deaconess Medical Centre, Boston, USA: Dr Christopher McCoy, Dr John Marshall, Dr Daniel Dalmor

Erasme Hospital, Free University of Brussels: Dr Fabio Taccone

Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra: Dr Antonio Margarit Ribas

University Hospital of Alexandroupolis, Greece: Prof Ioannis Pneumatikos, Dr Vassiliki Theodorou, Dr Georgios Kouliatsis, Dr Stylianos Fotakis, Dr Elias Christoforidis

Heidenheim Hospital, Heidenheim, Germany: Prof Otto Frey

Santiago, Chile: Nicole Salazar, Jana Stojanova, Leslie Escobar, Marcial Cariqueo

Brigham University USA: Ramona Hopkins

National University Hospital, Singapore: Dr Geetha Kayambu

Hong Kong Polytechnic University: Prof Alice Jones

Universitair Ziekenhuis Brussels, Belgium: Dr Herbert Spapen

Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium: Dr Joost Wauters

Clinique Saint Pierre, Ottignies, Belgium: Dr Thierry Dugernier

Universitair Ziekenhuis Antwerpen, Edegem, Belgium: Dr Philippe Jorens

Algemeen Ziekenhuis Monica, Deurne, Belgium: Dr Ilse Dapper

Hospital Del Mar, Barcelona, Spain: Dr Francisco Alvarez-Lerma, Dr Maria Pilar Gracia-Arnillas, Dr Sonia Luque

Centro Médico Delfos, Barcelona, Spain: Dr Francisco Fernández

Hospital General de L’Hospitalet, Barcelona, Spain: Dr Neus Feijoo, Dr Neus Bardolet, Dr Assumpta Rovira

Hospital General de Granollers, Barcelona, Spain: Dr Pau Garro, Dr Diana Colon

Hospital Txagorritxu, Vitoria, Spain: Dr Carlos Castillo, Dr Juan Fernado

Hospital Universitario de Burgos, Spain: Dr Maria Jesus Lopez, Dr Jose Luis  Fernandez, Dr Ana Maria Arribas

Hospital Universitario Marques de Valdecilla, Santander, Spain: Dr Jose Luis Teja, Dr Elsa Ots 

Hospital Universitario 12 de Octubre, Madrid, Spain: Dr Juan Carlos Montejo, Dr Mercedes Catalan

Hospital Ramon y Cajal, Madrid, Spain: Dr Isidro Prieto, Dr Gloria Gonzalo

Hospital Universitario La Paz, Madrid, Spain: Dr Beatriz Galvan

Hospital Universitario Severo Ochoa, Madrid, Spain: Dr Miguel Angel Blasco, Dr Estibaliz Meyer, Dr Frutos Del Nogal

Hospital Universitario de Donostia, Donostia, Spain: Dr Loreto Vidaur, Dr Rosa Sebastian, Dr Pila Marco Garde

Hospital Universitario Nuestra Señora de Candelaria, Spain: Dr Maria del Mar Martin Velasco

Hospital Universitario Dr. Peset, Spain: Dr Rafael Zaragoza Crespo

Institut Clínic del Tòrax, Hospital Clinic, Barcelona, Spain; Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CibeRes): Prof Mariano Esperatti, Prof Antoni Torres

University Hospital of Geneva, Switzerland: Prof Stephan Harbarth, Prof Angela Hunter

University Hospital of Wales , Wales: Prof Rishi Dhillon

Centre Hospitalier Pays D Aix, Aix en Provence; AzuRea Group, France: Prof Olivier Baldesi

Centre Hospitalier Universitaire d'Amiens, Amiens, France: Prof Herve Dupont

Centre Hospitalier-Universitaire d'Amiens; AzuRea Group, France: Prof Yazine Mahjoub

Centre Hospitalier-Universitaire d'Angers, France: Prof Sigismond Lasocki

Centre Hospitalier Universitaire de Clermont-Ferrand; AzuRea Group, France: Prof Jean Michel Constantin

Centre Hospitalier-Universitaire Grenoble; AzuRea Group, France: Prof Jean François Payen

Hopital Nord, Marseille; AzuRea Group, France: Prof Jacques Albanese

Hôpital Pontchaillou, Rennes, France: Prof Yannick Malledant

University Hospital, Strasbourg; AzuRea Group, France: Prof Julien Pottecher

Centre Hospitalier-Universitaire Nimes; AzuRea Group, France: Prof Jean-Yves Lefrant , Dr Claire Roger

Hospitalier-Universitaire Montpellier; AzuRea GroupFrance: Prof Samir Jaber

Centre Hospitalier-Universitaire Bordeaux; AzuRea Group, France: Prof Olivier Joannes-Boyau

Centre Hospitalier-Universitaire Nice; AzuRea Group, France: Prof Christophe Orban

Charing Cross Hospital, London, United Kingdom: Prof Francesca Rubulotta, Prof Anthony Gordon

St Thomas' Hospital, London, United Kingdom: Dr George Ntoumenopolous, Dr Marlies Ostermann, Prof Catherine McKenzie, Prof  William Berry, Prof John Smith, Prof Katie Lei

Hammersmith Hospital, Imperial Healthcare NHS Trust, London, United Kingdom: Prof Stephen Brett

St Mary's Hospital, Imperial Healthcare NHS Trust, London, United Kingdom: Prof Martin Stotz, Prof Maie Templeton

St George's Hospital, St George's Healthcare NHS Trust, London, United Kingdom: Prof Claudia Ebm, Prof Carl Moran

Helsinki University Central Hospital, Helsinki, Finland: Dr Kirsi-Maija Kaukonen, Dr Ville Pettilä

Azienda Ospedaliero Universitaria Careggi, Florence, Italy: Prof Chiara Adembri, Prof Gianluca Villa

Università degli Studi di Palermo, Palermo, Italy: Prof Antonio Giarratano, Prof Santi Maurizio Raineri, Prof Andrea Cortegiani, Prof Francesca Montalto, Prof Maria Strano

Universitaria San Giovanni-Battista Molinette, Turin, Italy: Prof V. Marco Ranieri, Prof Rosario, Prof Urbino Ilaria Mastromauro, Prof Francesco G. De Rosa

Catholic University School of Medicine, Rome, Italy: Prof Claudio Sandroni, Prof Gennaro De Pascale

University of Genoa, Genoa, Italy: Prof Alexandre Molin, Prof Paolo Pelosi

Universitaria San Martino, Genova, Italy: Prof Luca Montagnani

University of Udine, Udine, Italy: Prof Federico Pea

Hospital de Santo António, Porto, Portugal: Prof Teresa Cardoso

Hospital de St António dos Capuchos, Lisbon, Portgual: Prof Susana Afonso

Hospital de São Francisco Xavier, Lisbon, Portugal: Prof João Gonçalves-Pereira

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