Strategies for implementation of a multidisciplinary approach to the treatment of nosocomial infections in critically ill patients

Ignacio Martin-Loeches, Mark Metersky, Andre Kalil, Maria Diletta Pezzani, Antoni Torres

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Introduction: Intensive Care Units (ICU) are among the hospital wards exhibiting the highest prevalence of antimicrobial resistance (AMR), and resulting impact on patient outcomes. Antimicrobial resistance surveillance and antimicrobial stewardship (AMS) programs play a pivotal role in promoting interventions tailored to optimize infection diagnosis and treatment in the final attempt to limit unnecessary antimicrobial use and development of resistance. Areas covered: A narrative review of the literature was carried out to summarize the available evidence and develop a set of actions that should be considered for integration into the ICU stewardship framework. Four questions were addressed: how AMR surveillance can inform antibiotic policy in ICU; whether pharmacokinetic and pharmacodynamic (PK/PD) principles and the use of procalcitonin should be incorporated as a standard practice in ICU AMS programs to optimize antibiotic treatment and to drive antibiotic discontinuation; which criteria should drive treatment duration of ICU-associated infections. Expert opinion: In this review we aim to highlight that the ICU must be considered in its own right. Each ICU has its own characteristics depending on the country, on the local antibiotic resistance profile, on the patients feature and the severity of infection.

Original languageEnglish (US)
Pages (from-to)759-767
Number of pages9
JournalExpert Review of Anti-Infective Therapy
Volume19
Issue number6
DOIs
StatePublished - 2021

Keywords

  • ICU
  • PK/PD
  • Sepsis
  • VAP
  • VAT
  • pneumonia

ASJC Scopus subject areas

  • Microbiology
  • Microbiology (medical)
  • Virology
  • Infectious Diseases

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