Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement

Abstract

Background Antimicrobial resistance represents a major critical issue for the management of the critically ill patients hospitalized in the intensive care unit (ICU), since infections by multidrug-resistant bacteria are characterized by high morbidity and mortality, high rates of treatment failure, and increased healthcare costs worldwide. It is also well known that antimicrobial resistance can emerge as a result of inadequate antimicrobial therapy, in terms of drug selection and/or treatment duration. The application of antimicrobial stewardship principles in ICUs improves the quality of antimicrobial therapy management. However, it needs specific considerations related to the critical setting. Methods The aim of this consensus document gathering a multidisciplinary panel of experts was to discuss principles of antimicrobial stewardship in ICU and to produce statements that facilitate their clinical application and optimize their effectiveness. The methodology used was a modified nominal group discussion. Conclusion The final set of statements underlined the importance of the specific interpretation of antimicrobial stewardship’s principles in critically ill patient management, quasi-targeted therapy, the use of rapid diagnostic methods, the personalization of antimicrobial therapies’ duration, obtaining microbiological surveillance data, the use of PK/PD targets, and the use of specific indicators in antimicrobial stewardship programs.

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.…”

“…Additionally, all the targeted therapies need to be administered depending on the patient’s physiological conditions and the drug’s pharmacological features. Finally, the antimicrobial treatment should be monitored through specific biomarkers and clinical parameters to prevent unnecessary prolonged regimens [ 108 ].…”

“…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.…”

Presepsin in Critical Illness: Current Knowledge and Future Perspectives

“…However, the duration of antibiotic treatment often depends on the physician's judgment and may vary based on treatment protocols [50], leading in some cases to prolonged antibiotic use. Extended administration of antibiotics not only results in significant costs but also increases the risk of complications, mortality, and prolonged hospitalization [51,52]. PSP-guided therapy has shown promise in optimizing antibiotic use and guiding early interventions in septic patients [53].…”

Presepsin in Critical Illness: Current Knowledge and Future Perspectives

“…However, the duration of antibiotic treatment often depends on the physician’s judgment and may vary based on treatment protocols [ 56 ], leading in some cases to prolonged antibiotic use. Extended administration of antibiotics not only results in significant costs but also increases the risk of complications, mortality, and prolonged hospitalization [ 57 , 58 ].…”