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Antimicrobial stewardship in the intensive care unit: a focus on potential pitfalls
Jessica C Njoku1, Elizabeth D Hermsen
1Pharmacy Relations & Clinical Decision Support, The Nebraska Medical Center, Omaha, NE 68198-4031, USA.
Abstract:
Patients in the intensive care unit (ICU) have many risk factors for resistant pathogens such as prolonged length of stay, frequent and broad-spectrum antimicrobial therapy, presence of foreign materials, and proximity with other patients. However, of the risk factors associated with acquisition of resistant pathogens, inappropriate use of antimicrobial agents has been the most implicated. Thus, many health care institutions have adopted antimicrobial stewardship programs (ASPs) as a mechanism to ensure more appropriate antimicrobial use. ASPs can have a significant impact in the ICU, leading to improved antimicrobial use and resistance patterns and decreased infection rates and costs, due to the inherent nature of infections encountered and high and often inappropriate antibiotic utilization in this setting. However, certain challenges exist for ASPs in the ICU including issues with infrastructure and personnel, information technology, the core ASP strategy, patient-specific factors, conversion of intravenous to oral therapy, and dose optimization. The combination of comprehensive infection control (IC) and effective antimicrobial stewardship can prevent the emergence of resistance among microorganisms and may decrease the negative consequences associated with antimicrobial misuse.
Insights
Antimicrobial stewardship programs (ASPs) in intensive care units (ICUs) improve antimicrobial use and reduce infection rates. Challenges in implementation exist, but combining ASPs with infection control (IC) combats resistant pathogens.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Public Health
Background:
- Intensive care unit (ICU) patients face high risks for resistant pathogens due to factors like prolonged stays and broad-spectrum antibiotic use.
- Inappropriate antimicrobial agent use is a primary driver of resistant pathogen acquisition in ICUs.
- Antimicrobial stewardship programs (ASPs) are implemented to optimize antimicrobial prescribing practices.
Purpose of the Study:
- To evaluate the impact and challenges of antimicrobial stewardship programs (ASPs) in intensive care units (ICUs).
- To highlight the role of ASPs in improving antimicrobial use and combating resistance.
- To emphasize the synergy between infection control (IC) and ASPs.
Main Methods:
- Review of risk factors for resistant pathogens in ICUs.
- Analysis of the role and impact of antimicrobial stewardship programs (ASPs).
- Discussion of challenges faced by ASPs in the ICU setting.
Main Results:
- ASPs significantly improve antimicrobial use, resistance patterns, infection rates, and reduce costs in ICUs.
- Key challenges for ICU ASPs include infrastructure, personnel, IT, strategy, patient factors, and therapy optimization.
- Comprehensive infection control (IC) combined with effective ASPs can prevent resistance and mitigate misuse consequences.
Conclusions:
- Antimicrobial stewardship programs are crucial for managing resistant pathogens in ICUs.
- Addressing implementation challenges is vital for maximizing ASP effectiveness in critical care settings.
- Integrated infection control and antimicrobial stewardship strategies are essential for combating antimicrobial resistance.
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