Antimicrobial Stewardship Techniques for Critically Ill Patients with Pneumonia

Abstract

Pneumonia is common in the intensive care unit (ICU), infecting 27% of all critically ill patients. Given the high prevalence of this disease state in the ICU, optimizing antimicrobial therapy while minimizing toxicities is of utmost importance. Inappropriate antimicrobial use can increase the risk of antimicrobial resistance, Clostridiodes difficile infection, allergic reaction, and other complications from antimicrobial use (e.g., QTc prolongation, thrombocytopenia). This review article aims to discuss methods to optimize antimicrobial treatment in patients with pneumonia, including the following: procalcitonin use, utilization of methicillin-resistant Staphylococcus aureus nares testing to determine need for vancomycin therapy, utilization of the Biofire® FilmArray® pneumonia polymerase chain reaction (PCR), and microbiology reporting techniques.

Pseudomonas aeruginosa Infections in Patients with Severe COVID-19 in Intensive Care Units: A Retrospective Study

“…The use of antibiotics in ICUs is crucial for treating patients infected with bacteria such as P. aeruginosa. However, the proper use of antibiotics is essential for fighting antibiotic resistance and reducing the side effects of treatment [34]. Unfortunately, we highlighted the fact that probabilistic antibiotic treatment was prescribed for 96% of patients and was only adapted for 51% of patients after receiving an antibiogram and 33% of patients after receiving a noncompliant antibiotic plasma dosage.…”

“…All patients (100%) received oxygenation support during their ICU stay: 22% were treated by extracorporeal membrane oxygenation, and 94% were treated with invasive mechanical ventilation for a median length of 30 days (Q1-Q3: [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. The use of prone positioning, corticosteroids, and neuromuscular blockers was prescribed for most patients (86%, 69%, and 61%, respectively).…”

Ten Issues for Updating in Community-Acquired Pneumonia: An Expert Review

“…In the case of community-acquired pneumonia (CAP), early identification of the causative pathogen is crucial to guide antibiotic therapy, prevent the emergence of antimicrobial re-sistance, and reduce avoidable drug adverse effects [31]. However, approximately 30-50% of all CAP cases lack an etiologic diagnosis and, in most cases, the treatment is empirical [32,33]. New diagnosis tools such as point-of-care (POC) tests or rapid respiratory syndromic panels may have a positive effect on microbiological diagnosis of patients with CAP, although its impact on outcomes is controversial [32].…”

“…Over the last few years, commercially available nucleic acid amplification technologies have emerged as the diagnostic tools of choice for respiratory pathogens, particularly viruses, but also for the detection of difficult to grow bacteria and some resistance genes. These molecular assays should be used for the detection of influenza viruses when these are circulating in the community and for the detection of SARS-CoV-2 [31,33,34]. During periods of low influenza activity, testing must be considered, especially in immunocompromised patients.…”

“…It is also necessary to emphasize that this testing recommendation has both therapeutic and infection-control implications in the hospital setting [31]. At present, the wide availability of commercialized rapid respiratory syndromic panels has shortened the diagnostic turnaround time to one to five hours and is less likely to be affected by prior antibiotic administration [33,38]. The benefits of these rapid syndromic panels include their high sensitivity, specificity, and negative predictive value when used in conjunction with expert interpretation, but they should not replace conventional culture and antimicrobial susceptibility testing.…”