Antimicrobial stewardship in critical care.

Area of Science:

• Critical care medicine
• Infectious diseases
• Public health

Background:

• Antimicrobial resistance (AMR) poses a significant global health threat, primarily due to inappropriate antibiotic usage.
• Effective antimicrobial stewardship (AMS) is crucial for mitigating AMR, especially in critical care settings.

Purpose of the Study:

• To review current principles and practices of AMS in critical care.
• To explore strategies for combating AMR and optimizing patient outcomes through responsible antimicrobial use.

Main Methods:

• Review of global AMR burden, resistance mechanisms, and AMS implementation.
• Analysis of multidisciplinary, diagnostic, and pharmacokinetic approaches to AMS.
• Examination of rapid diagnostics, biomarkers (e.g., procalcitonin), and EHR integration.

Main Results:

• AMS strategies enhance antimicrobial efficacy and minimize resistance development.
• Targeted therapy and improved outcomes are facilitated by diagnostics and EHRs.
• Special populations (transplant, sepsis) require tailored AMS approaches for optimization and resistance prevention.

Conclusions:

• Responsible antimicrobial use across all settings is essential.
• Continuous education, surveillance, and adaptive AMS policies are necessary.
• Global cooperation and infrastructure investment are vital for addressing implementation challenges, particularly in low-resource settings.