Feasibility of Antimicrobial Stewardship (AMS) in Critical Care Settings: A Multidisciplinary Approach Strategy

Abstract

Antimicrobial resistance is escalating and triggers clinical decision-making challenges when treating infections in patients admitted to intensive care units (ICU). Antimicrobial stewardship (AMS) may help combat this problem, but it can be difficult to implement in critical care settings. The implementation of multidisciplinary AMS in ICUs could be more challenging than what is currently suggested in the literature. Our main goal was to analyze the reduction in duration of treatment (DOT) for the most commonly used antibacterial and antifungal agents during the first six months of 2014, and during the same period two years later (2016). A total of 426 and 424 patient encounters, respectively, were documented and collected from the intensive care unit’s electronic patient record system. Daily multidisciplinary ward rounds were conducted for approximately 30–40 min, with the goal of optimizing antimicrobial therapy in order to analyze the feasibility of implementing AMS. The only antimicrobial agent which showed a significant reduction in the number of prescriptions and in the duration of treatment during the second audit was vancomycin, while linezolid showed an increase in the number of prescriptions with no significant prolongation of the duration of treatment. A trend of reduction was also seen in the DOT for co-amoxiclavulanate and in the number of prescriptions of anidulafungin without any corresponding increases being observed for other broad-spectrum anti-infective agents (p-values of 0.07 and 0.05, respectively).

Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients

“…The main principles of ASP are to promote the appropriate use of antimicrobials (including antibiotics), improve patient outcomes, reduce antimicrobial resistance, and decrease the spread of infections caused by multidrug-resistant organisms. There are many ways to implement such programs, but a multidisciplinary approach with coordination among the attending physicians, nurses, and pharmacists is the most important factor [ 30 , 31 ]. In the following section, we further discuss the roles of the biomarkers that are a key element of ASP.…”

The European Network for ICU-Related Respiratory Infections (ENIRRIs) ERS Clinical Research Collaboration

“…It is also very relevant that many of the antibiotic choices that have been published in international guidelines, while they also refer to hospital-acquired pneumonia, are very heterogeneous and treatment choices are randomly assigned depending on the attending team [11]. The emergence of antibiotic stewardship teams has helped in making adequate antibiotic choices based on the patient's risk factors, shortening treatment duration and ensuring de-escalation in a timely manner [12].…”

The Role of Electronic Medical Record in Enhancing Rational Antibiotics Prescription: A Systematic Review

“…After the three visited the patient and made an assessment, a recommendation was issued as input to the patient's physician in charge. The amount of prescription and duration of vancomycin and co-amoxiclav therapy decreased compared without the involvement of the 3 disciplines (Tiszai-Szucs et al, 2018). Nasr et al (2019) evaluate the administration of antibiotics in cancer patients who have infections with PDSA tools (Plan, Do, Study, Act), then conduct promotional education to multidisciplinary experts (doctors and pharmacists) about antibiotic management programs continuously and assesses problems experienced when do rational antibiotic therapy in patients.…”