A Practical Approach to Clinical Antibiotic Stewardship in the ICU Patient with Severe Infection

Fierens, Jan; Depuydt, Pieter; Waele, Jan J. De

doi:10.1055/s-0039-1693995

Cited by 12 publications

(8 citation statements)

References 140 publications

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“…The critically ill patient is the highest per-capita antimicrobial consumer [1,4]. Moreover, critical illness itself, risks of organ support, and inherent immunosuppression of the majority of ICU patients all confer a predisposition for infectious complications [2] as well as unpredictable changes in PK and PD of AMT.…”

Section: Antimicrobial Stewardship: What Is the Problem?mentioning

confidence: 99%

“…The large burden of AMT consumption in the ICU setting should motivate intensivists to become active participants in developing, implementing, and promoting ASP. These should strive to reduce antibiotic consumption, resistance, and adverse side effects, whilst improving patient outcomes and economic burden [2,29]. A team approach and use of clinical decision support systems are helpful adjuncts for ASP improvement.…”

Section: Antibiotic Stewardship Programs In Icumentioning

confidence: 99%

“…Infections are not only common causes of intensive care unit (ICU) admission but also frequent culprits of ICU-associated complications [1][2][3]. Although the beneficial aspects of antimicrobial therapy (AMT) are well acknowledged, the potentially associated harms are often underestimated [4].…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial Stewardship in the Intensive Care Unit: The Role of Biomarkers, Pharmacokinetics, and Pharmacodynamics

2020

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The high prevalence of infectious diseases in the intensive care unit (ICU) and consequently elevated pressure for immediate and effective treatment have led to increased antimicrobial therapy consumption and misuse. Moreover, the emerging global threat of antimicrobial resistance and lack of novel antimicrobials justify the implementation of judicious antimicrobial stewardship programs (ASP) in the ICU. However, even though the importance of ASP is generally accepted, its implementation in the ICU is far from optimal and current evidence regarding strategies such as de-escalation remains controversial. The limitations of clinical guidance for antimicrobial therapy initiation and discontinuation have led to multiple studies for the evaluation of more objective tools, such as biomarkers as adjuncts for ASP. C-reactive protein and procalcitonin can be adequate for clinical use in acute infectious diseases, the latter being the most studied for ASP purposes. Although promising, current evidence highlights challenges in biomarker application and interpretation. Furthermore, the physiological alterations in the critically ill render pharmacokinetics and pharmacodynamics crucial parameters for adequate antimicrobial therapy use. Individual pharmacokinetic and pharmacodynamic targets can reduce antimicrobial therapy misuse and risk of antimicrobial resistance.

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Section: Antimicrobial Stewardship: What Is the Problem?mentioning

confidence: 99%

Section: Antibiotic Stewardship Programs In Icumentioning

confidence: 99%

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Antimicrobial Stewardship in the Intensive Care Unit: The Role of Biomarkers, Pharmacokinetics, and Pharmacodynamics

2020

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“…Accordingly, antibiotic decisions have high levels of consultant intensivist and microbiologist involvement, and ICU-specific AMS programmes have been developed. 7 8 Yet up to 70% of ICU patients receive antimicrobial therapy, 9 despite up to half having no confirmed infection. 2 …”

Section: Introductionmentioning

confidence: 99%

Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework

et al. 2021

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BackgroundAntibiotics are extensively prescribed in intensive care units (ICUs), yet little is known about how antibiotic-related decisions are made in this setting. We explored how beliefs, perceptions and contextual factors influenced ICU clinicians’ antibiotic prescribing.MethodsWe conducted 4 focus groups and 34 semistructured interviews with clinicians involved in antibiotic prescribing in four English ICUs. Focus groups explored factors influencing prescribing, whereas interviews examined decision-making processes using two clinical vignettes. Data were analysed using thematic analysis, applying the Necessity Concerns Framework.ResultsClinicians’ antibiotic decisions were influenced by their judgement of the necessity for prescribing/not prescribing, relative to their concerns about potential adverse consequences. Antibiotic necessity perceptions were strongly influenced by beliefs that antibiotics would protect patients from deterioration and themselves from the ethical and legal consequences of undertreatment. Clinicians also reported concerns about prescribing antibiotics. These generally centred on antimicrobial resistance; however, protecting the individual patient was prioritised over these societal concerns. Few participants identified antibiotic toxicity concerns as a key influencer. Clinical uncertainty often complicated balancing antibiotic necessity against concerns. Decisions to start or continue antibiotics often represented ‘erring on the side of caution’ as a protective response in uncertainty. This approach was reinforced by previous experiences of negative consequences (‘being burnt’) which motivated prescribing ‘just in case’ of an infection. Prescribing decisions were also context-dependent, exemplified by a lower perceived threshold to prescribe antibiotics out-of-hours, input from external team members and local prescribing norms.ConclusionEfforts to improve antibiotic stewardship should consider clinicians’ desire to protect with a prescription. Rapid molecular microbiology, with appropriate communication, may diminish clinicians’ fears of not prescribing or of using narrower-spectrum antibiotics.

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“…The two-step mechanism initiated by a physiochemical process is less likely to acquire resistance, , and the later ultrasound stimulation can confine the damage in the interested area. Moreover, in contrast to time-consuming antibiotics or cationic peptides treatments, − this approach only requires several minutes of ultrasound detonation. Another potential advantage of NE might be its biosafety for mammalian cells.…”

mentioning

confidence: 99%

Nano-Emulsified Perfluorooctyl Bromide Can Infiltrate Gram-Negative Bacteria and Sensitize Them to Ultrasound

Yang,

Zhang,

Sun

et al. 2023

Nano Lett.

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Gram-negative (G−) bacterial infections remain one of the most urgent global health threats, because the distinctive envelope structure hinders the penetration of therapeutics. Here, we showed that a perfluorooctyl bromide nanoemulsion (PFOB NE) uniquely interacts with G− bacteria. After cell envelope attachment, the PFOB can infiltrate the cell and was diffused throughout. In this process, it impaired the membranes by disintegrating phospholipid molecules, enhancing the consequent ultrasonic cavitation to break the envelope. We identified through ultrasound that the NE had remarkable bactericidal effects against various antibiotic-resistant pathogens. Using in situ sterilization, this approach accelerated the recovery of bacteria-infected murine skin wounds. Thus, combining PFOB and ultrasound might be an alternative tool for conquering the growing threat of G− pathogens.

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A Practical Approach to Clinical Antibiotic Stewardship in the ICU Patient with Severe Infection

Cited by 12 publications

References 140 publications

Antimicrobial Stewardship in the Intensive Care Unit: The Role of Biomarkers, Pharmacokinetics, and Pharmacodynamics

Antimicrobial Stewardship in the Intensive Care Unit: The Role of Biomarkers, Pharmacokinetics, and Pharmacodynamics

Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework

Nano-Emulsified Perfluorooctyl Bromide Can Infiltrate Gram-Negative Bacteria and Sensitize Them to Ultrasound

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