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Updated: Sep 2, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Antimicrobial stewardship
Christian Lanckohr1, Hendrik Bracht2
1Antibiotic Stewardship Team, Institute of Hygiene, University Hospital Münster, Münster.
Purpose Of Review:
The optimal use of antimicrobials is necessary to slow resistance development and improve patient outcomes. Antimicrobial stewardship (AMS) is a bundle of interventions aimed at promoting the responsible use of antiinfectives. The ICU is an important field of activity for AMS because of high rates of antimicrobial use, high prevalence of resistant pathogens and complex pharmacology. This review discusses aims and interventions of AMS with special emphasis on the ICU.
Recent Findings:
AMS-interventions can improve the quality and quantity of antimicrobial prescribing in the ICU without compromising patient outcomes. The de-escalation of empiric therapy according to microbiology results and the limitation of treatment duration are important steps to reduce resistance pressure. Owing to the complex nature of critical illness, the pharmacological optimization of antimicrobial therapy is an important goal in the ICU. AMS-objectives and strategies are also applicable to patients with sepsis. This is reflected in the most recent guidelines by the Surviving Sepsis Campaign. AMS-interventions need to be adapted to their respective setting and be mindful of local prescribing cultures and prescribers' attitudes.
Summary:
AMS in the ICU is effective and safe. Intensivists should be actively involved in AMS-programs and propagate responsible use of antimicrobials.
Insights
Antimicrobial stewardship (AMS) programs in the intensive care unit (ICU) are effective and safe, improving antimicrobial prescribing. Key interventions include de-escalation and limiting treatment duration to combat resistance.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Optimal antimicrobial use is crucial for slowing resistance and improving patient outcomes.
- Antimicrobial stewardship (AMS) encompasses interventions promoting responsible anti-infective use.
- The ICU presents unique challenges due to high antimicrobial use, resistant pathogens, and complex pharmacology.
Purpose of the Study:
- To review the aims and interventions of AMS, with a specific focus on the ICU setting.
- To highlight the importance of AMS in optimizing antimicrobial prescribing in critical care.
- To discuss the applicability of AMS strategies to sepsis management.
Main Methods:
- Review of current literature and guidelines on antimicrobial stewardship in the ICU.
- Analysis of effective AMS interventions, including de-escalation and treatment duration limitation.
- Discussion of pharmacological optimization of antimicrobial therapy in critically ill patients.
Main Results:
- AMS interventions can enhance antimicrobial prescribing quality in the ICU without negatively impacting patient outcomes.
- De-escalation of empiric therapy and reduced treatment duration are key to mitigating resistance.
- Pharmacological optimization of antimicrobials is essential in the complex ICU environment.
Conclusions:
- Antimicrobial stewardship in the ICU is both effective and safe.
- Intensivists play a vital role in AMS programs and promoting responsible antimicrobial use.
- AMS strategies must be tailored to local contexts, considering prescribing cultures and prescriber attitudes.
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