Antibiotic stewardship in the ICU: time to shift into overdrive

Abstract

Antibiotic resistance is a major health problem and will be probably one of the leading causes of deaths in the coming years. One of the most effective ways to fight against resistance is to decrease antibiotic consumption. Intensive care units (ICUs) are places where antibiotics are widely prescribed, and where multidrug-resistant pathogens are frequently encountered. However, ICU physicians may have opportunities to decrease antibiotics consumption and to apply antimicrobial stewardship programs. The main measures that may be implemented include refraining from immediate prescription of antibiotics when infection is suspected (except in patients with shock, where immediate administration of antibiotics is essential); limiting empiric broad-spectrum antibiotics (including anti-MRSA antibiotics) in patients without risk factors for multidrug-resistant pathogens; switching to monotherapy instead of combination therapy and narrowing spectrum when culture and susceptibility tests results are available; limiting the use of carbapenems to extended-spectrum beta-lactamase-producing Enterobacteriaceae, and new beta-lactams to difficult-to-treat pathogen (when these news beta-lactams are the only available option); and shortening the duration of antimicrobial treatment, the use of procalcitonin being one tool to attain this goal. Antimicrobial stewardship programs should combine these measures rather than applying a single one. ICUs and ICU physicians should be at the frontline for developing antimicrobial stewardship programs.

Stop in Time: How to Reduce Unnecessary Antibiotics in Newborns with Late-Onset Sepsis in Neonatal Intensive Care

“…Blood cultures can have a crucial role also in switching multiple antibiotic therapies towards monotherapy, narrowing the spectrum of our treatment when cultures and susceptibility tests’ results become available [ 56 ].…”

Bacterial Infections in Intensive Care Units: Epidemiological and Microbiological Aspects

“…Antimicrobial consumption is one of the most relevant concerns in ICU settings, mostly due to empirical broad-spectrum treatments on critical patients. Such fragile subjects and their severe infections made the antimicrobial stewardship (AMS) programs’ formation essential [ 108 , 109 ]. These programs aim to monitor antimicrobial use and dosage, optimize possible microorganisms’ elimination, and reduce treatment duration, impacting patients’ management and recovery costs.…”

“…These programs aim to monitor antimicrobial use and dosage, optimize possible microorganisms’ elimination, and reduce treatment duration, impacting patients’ management and recovery costs. The mentioned aims require a multidisciplinary committee consisting of microbiologists, epidemiologists, pharmacologists, infectious disease specialists, and other targeted clinicians [ 109 ]. The ultimate AMS goal is to minimize and contain antimicrobial resistance in critical settings.…”

“…The AMS strategies require frequent educational programs for all the involved healthcare personnel with a standardized consensus document about all the aims and protocols. In conclusion, economic and logistic support are vital to plan and reach the AMS goals [ 108 , 109 ]. For instance, clinicians may promptly identify the urgency of an ICU patient’s condition through laboratory biomarkers, imaging, symptoms, and clinical scores.…”

Preventing Multidrug-Resistant Bacterial Transmission in the Intensive Care Unit with a Comprehensive Approach: A Policymaking Manual

“…This can be achieved by ensuring the correct dosing, choosing the appropriate antibiotic, and regulating the duration and route of administration [ 67 ]. These elements of ASPs can collectively reduce the overall exposure to antibiotics and therefore minimize the emergence of the resistance and colonization of MDR bacteria [ 68 ]. This allows healthcare providers to identify patterns in antibiotic use and hence identify overuse or misuse.…”