RT Journal Article
T1 Rationalizing antimicrobial therapy in the ICU: a narrative review.
A1 Timsit, Jean-François
A1 Bassetti, Matteo
A1 Cremer, Olaf
A1 Daikos, George
A1 de Waele, Jan
A1 Kallil, Andre
A1 Kipnis, Eric
A1 Kollef, Marin
A1 Laupland, Kevin
A1 Paiva, Jose-Artur
A1 Rodríguez-Baño, Jesús
A1 Ruppé, Étienne
A1 Salluh, Jorge
A1 Taccone, Fabio Silvio
A1 Weiss, Emmanuel
A1 Barbier, François
K1 Antibiotic stewardship
K1 Antimicrobial resistance
K1 Carbapenem
K1 Critical illness
K1 Empirical therapy
K1 Outcome
K1 Sepsis
AB 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.
YR 2019
FD 2019-01-18
LK http://hdl.handle.net/10668/13434
UL http://hdl.handle.net/10668/13434
LA en
DS RISalud
RD Apr 9, 2025