Antimicrobial Stewardship Approaches in the Intensive Care Unit

Infect Dis Clin North Am. 2017 Sep;31(3):513-534. doi: 10.1016/j.idc.2017.05.002. Epub 2017 Jul 5.

Abstract

Antimicrobial stewardship programs aim to monitor, improve, and measure responsible antibiotic use. The intensive care unit (ICU), with its critically ill patients and prevalence of multiple drug-resistant pathogens, presents unique challenges. This article reviews approaches to stewardship with application to the ICU, including the value of diagnostics, principles of empirical and definitive therapy, and measures of effectiveness. There is good evidence that antimicrobial stewardship results in more appropriate antimicrobial use, shorter therapy durations, and lower resistance rates. Data demonstrating hard clinical outcomes, such as adverse events and mortality, are more limited but encouraging; further studies are needed.

Keywords: Antibacterial resistance; Antimicrobial stewardship; Clostridium difficile infection; Computerized decision support; Formulary restriction; Prospective audit and feedback; Rapid diagnostics.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Infective Agents / administration & dosage
  • Anti-Infective Agents / adverse effects
  • Anti-Infective Agents / therapeutic use*
  • Antimicrobial Stewardship*
  • Clostridium Infections / diagnosis
  • Clostridium Infections / drug therapy
  • Clostridium difficile / drug effects
  • Decision Support Systems, Clinical
  • Enterobacteriaceae / drug effects
  • Enterobacteriaceae / isolation & purification
  • Enterobacteriaceae Infections / diagnosis
  • Enterobacteriaceae Infections / drug therapy
  • Enterobacteriaceae Infections / microbiology
  • Humans
  • Intensive Care Units*
  • Middle Aged
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Anti-Infective Agents