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Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a
Andrea Cortegiani1,2, Massimo Antonelli3,4, Marco Falcone5
1Department of Surgical, Oncological and Oral Science, University of Palermo, Via Liborio Giuffrè 5, 90127, Palermo, Italy. andrea.cortegiani@unipa.it.
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.
Insights
Antimicrobial resistance in intensive care units (ICUs) requires tailored antimicrobial stewardship. This consensus document provides key statements for optimizing therapy in critically ill patients.
Area of Science:
- Critical care medicine
- Infectious diseases
- Pharmacology
Background:
- Antimicrobial resistance (AMR) in intensive care units (ICUs) leads to high morbidity, mortality, and healthcare costs.
- Inadequate antimicrobial therapy contributes to the emergence of multidrug-resistant bacteria.
- Antimicrobial stewardship programs (ASPs) are crucial for improving antimicrobial therapy in ICUs, but require specific adaptations.
Purpose of the Study:
- To discuss and establish consensus statements on antimicrobial stewardship principles specifically for the ICU setting.
- To provide guidance for the effective clinical application of antimicrobial stewardship in critically ill patients.
Main Methods:
- A modified nominal group discussion methodology was employed.
- A multidisciplinary panel of experts convened to discuss and formulate statements.
Main Results:
- Key statements emphasize tailored antimicrobial stewardship for critically ill patients.
- Recommendations include quasi-targeted therapy, rapid diagnostics, personalized treatment duration, and microbiological surveillance.
- The use of pharmacokinetic/pharmacodynamic (PK/PD) targets and specific ASP indicators are highlighted.
Conclusions:
- Effective antimicrobial stewardship in ICUs necessitates specific adaptations of general principles.
- Optimizing antimicrobial therapy in critically ill patients requires a multifaceted approach.
- Implementation of these statements can improve outcomes and combat antimicrobial resistance in the ICU.
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