Antibiotic Decision-Making in the ICU

Guillamet, M Cristina Vazquez

doi:10.1055/s-0041-1741014

Cited by 3 publications

(6 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, improving the predictability of clinical symptoms or any other available data on the current patient would result in a reduction in the administration of broad-spectrum antibiotics. This conclusion supports Parra-Rodriguez et al [14] who emphasized the importance of rapid diagnostic tests (RDTs) in the ICU. We showed that these RDTs may help reduce the use of broad-spectrum antibiotics even if they cannot provide certain identification of the pathogen, but merely improve the probabilistic information available for the physician.…”

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

“…Other studies have analyzed the clinical aspects of this decision making problem. For example, Parra-Rodriguez et al [14] elaborated on the information available to the physician throughout the decision process, and the possible role of decision support systems. Barash et al [15] emphasized the importance of performing proper and non-biased analytical reasoning by the physician.…”

Section: Introductionmentioning

confidence: 99%

“…One possible direction is to employ methods of collaborative management and consensus-based regulation of antibiotic prescribing [10]. Another recommended direction is the uptake and integration of decision support systems [14], which combine the patient's personal data with environment and population-level and data, and thus improve antibiotic choices and help implementing socially optimal considerations. Nevertheless, before implementing any measures intended to decrease antibiotic misuse, the management or regulator who chooses and designs these measures must take into consideration that physicians are rational players.…”

mentioning

confidence: 99%

See 3 more Smart Citations

The straight and narrow: a game theory model of broad- and narrow-spectrum empiric antibiotic therapy

Diamant¹,

Obolski²

2023

Preprint

View full text Add to dashboard Cite

Physicians prescribe empiric antibiotic treatment when definitive knowledge of the pathogen causing an infection is lacking. The options of empiric treatment can be largely divided into broad- and narrow-spectrum antibiotics. Prescribing a broad-spectrum antibiotic increases the chances of covering the causative pathogen, and hence benefits the current patient's recovery. However, prescription of broad-spectrum antibiotics also accelerates the expansion of antibiotic resistance, potentially harming future patients. We analyze the social dilemma using game theory. In our game model, physicians choose between prescribing broad and narrow-spectrum antibiotics to their patients. Their decisions rely on the probability of an infection by a resistant pathogen before definitive laboratory results are available. We prove that whenever the equilibrium strategies differ from the socially optimal policy, the deviation is always towards a more excessive use of the broad-spectrum antibiotic. We further show that if prescribing broad-spectrum antibiotics only to patients with a high probability of resistant infection is the socially optimal policy, then decentralization of the decision making may make this policy individually irrational, and thus sabotage its implementation. We discuss the importance of improving the probabilistic information available to the physician and promoting centralized decision making.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

The straight and narrow: a game theory model of broad- and narrow-spectrum empiric antibiotic therapy

Diamant¹,

Obolski²

2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Antibiotic decision-making in the ICU-both prescribing, changing and terminating treatment-is difficult even when using standard paraclinical tools for decision-making such as temperature and a wide set of infections parameters, e.g. C-reactive protein (CRP) and Procalcitonin [3][4][5]. Distinguishment between infection and inflammation remains a big challenge, and a wrong decision might result in either increased mortality or enhanced microbial resistance [3].…”

Section: Introductionmentioning

confidence: 99%

Exhaled nitric oxide in intubated ICU patients on mechanical ventilation—a feasibility study

Kofoed,

Hindborg,

Hjembæk-Brandt

et al. 2023

J. Breath Res.

View full text Add to dashboard Cite

Background: It can be a clinical challenge to distinguish inflammation from infection in critically ill patients. Therefore, valid and conclusive surrogate markers for infections are desired. Nitric oxide (NO) might be that marker since concentrations of exhaled NO have shown to change in the presence of various diseases.This observational, prospective, single-center feasibility study aimed to investigate if fractional exhaled NO (FeNO) can be measured in intubated patients with or without infection, pneumonia and septic shock in a standardized, reliable setting.Methods: 20 intubated patients in the intensive care unit (ICU) were included for analysis. FeNO mean values were measured in the endotracheal tube via the suction channel using a chemiluminescence based analyzer. Results: We developed a pragmatic method to measure FeNO repeatedly and reliably in intubated patients using a chemiluminescence based analyzer. We found a median of 0.98 (0.59-1.44) FeNO mean (ppb) in exhaled breath from all 20 intubated patient. Intubated patient with suspected infection had a significantly lower median FENO mean compared with the intubated patients without suspected infection. Similarly did patients with septic shock demonstrate a significantly lower median FENO mean than without septic shock. We found no statistical difference in median FeNO mean for intubated patients with pneumonia.Conclusion: It was feasible to measure FeNO in intubated patients in the ICU. Our results indicate decreased levels of FeNO in infected intubated patients in the ICU. The study was not powered to provide firm conclusions, so larger trials are needed to confirm the results and to prove FeNO as a useful biomarker for distinguishment between infection and inflammation in the ICU.

show abstract

Antimicrobial Stewardship in Pediatric Emergency Medicine: A Narrative Exploration of Antibiotic Overprescribing, Stewardship Interventions, and Performance Metrics

Meesters,

Buonsenso

2024

Children

View full text Add to dashboard Cite

Antibiotic overprescribing is prevalent in pediatric emergency medicine, influenced by clinician–caregiver dynamics and diagnostic uncertainties, and poses substantial risks such as increasing antibacterial resistance, adverse drug reactions, and increased healthcare expenditures. While antimicrobial stewardship programs have proven effective in optimizing antibiotic use within inpatient healthcare settings, their implementation in pediatric emergency medicine presents specific challenges. Existing biomarkers like white blood cell count, C-reactive protein, procalcitonin, and presepsin have limitations in their ability to distinguish (serious) bacterial infections from other etiologies of fever. Furthermore, rapid antigen detection tests and guidelines aimed at guiding antibiotic prescriptions for children have not consistently reduced unnecessary antibiotic use. To improve antibiotic prescribing practices, potential strategies include the utilization of decision support tools, audit and feedback, establishing follow-up procedures, implementing safety netting systems, and delivering comprehensive training and supervision. Notably, host genome signatures have also gained attention for their potential to facilitate rapid and precise diagnoses of inflammatory syndromes. Standardized metrics are crucial for evaluating antimicrobial use within pediatric healthcare settings, enabling the establishment of benchmarks for assessing antibiotic utilization, quality enhancement initiatives, and research endeavors.

show abstract

Antibiotic Decision-Making in the ICU

Cited by 3 publications

References 62 publications

The straight and narrow: a game theory model of broad- and narrow-spectrum empiric antibiotic therapy

The straight and narrow: a game theory model of broad- and narrow-spectrum empiric antibiotic therapy

Exhaled nitric oxide in intubated ICU patients on mechanical ventilation—a feasibility study

Antimicrobial Stewardship in Pediatric Emergency Medicine: A Narrative Exploration of Antibiotic Overprescribing, Stewardship Interventions, and Performance Metrics

Contact Info

Product

Resources

About