Τίτλος:
Rationalizing antimicrobial therapy in the ICU: a narrative review
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
The massive consumption of antibiotics in the ICU is responsible for substantial ecological side effects that promote the dissemination of multidrug-resistant bacteria (MDRB) in this environment. Strikingly, up to half of ICU patients receiving empirical antibiotic therapy have no definitively confirmed infection, while de-escalation and shortened treatment duration are insufficiently considered in those with documented sepsis, highlighting the potential benefit of implementing antibiotic stewardship programs (ASP) and other quality improvement initiatives. The objective of this narrative review is to summarize the available evidence, emerging options, and unsolved controversies for the optimization of antibiotic therapy in the ICU. Published data notably support the need for better identification of patients at risk of MDRB infection, more accurate diagnostic tools enabling a rule-in/rule-out approach for bacterial sepsis, an individualized reasoning for the selection of single-drug or combination empirical regimen, the use of adequate dosing and administration schemes to ensure the attainment of pharmacokinetics/pharmacodynamics targets, concomitant source control when appropriate, and a systematic reappraisal of initial therapy in an attempt to minimize collateral damage on commensal ecosystems through de-escalation and treatment-shortening whenever conceivable. This narrative review also aims at compiling arguments for the elaboration of actionable ASP in the ICU, including improved patient outcomes and a reduction in antibiotic-related selection pressure that may help to control the dissemination of MDRB in this healthcare setting. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
Συγγραφείς:
Timsit, J.-F.
Bassetti, M.
Cremer, O.
Daikos, G.
de Waele, J.
Kallil, A.
Kipnis, E.
Kollef, M.
Laupland, K.
Paiva, J.-A.
Rodríguez-Baño, J.
Ruppé, É.
Salluh, J.
Taccone, F.S.
Weiss, E.
Barbier, F.
Περιοδικό:
Intensive Care Medicine Experimental
Λέξεις-κλειδιά:
antibiotic agent; beta lactam antibiotic; antiinfective agent, antibiotic resistance; antibiotic therapy; antimicrobial stewardship; bacterial infection; chronopharmacology; critical illness; critically ill patient; drug monitoring; early diagnosis; extended spectrum beta lactamase producing Enterobacteriaceae; human; immune status; immunocompromised patient; infection risk; intensive care unit; multidrug resistance; nonhuman; prescription; Review; time to treatment; total quality management; treatment duration; treatment outcome; antimicrobial stewardship; defense mechanism; health service; intensive care unit; organization and management; prevention and control; procedures; risk factor, Anti-Infective Agents; Antimicrobial Stewardship; Humans; Intensive Care Units; Medical Overuse; Rationalization; Risk Factors
DOI:
10.1007/s00134-019-05520-5
