Antibiotic Stewardship in the Intensive Care Unit. An Official American Thoracic Society Workshop Report in Collaboration with the AACN, CHEST, CDC, and SCCM

Abstract

Intensive care units (ICUs) are an appropriate focus of antibiotic stewardship program efforts because a large proportion of any hospital's use of parenteral antibiotics, especially broad-spectrum, occurs in the ICU. Given the importance of antibiotic stewardship for critically ill patients and the importance of critical care practitioners as the front line for antibiotic stewardship, a workshop was convened to specifically address barriers to antibiotic stewardship in the ICU and discuss tactics to overcome these. The working definition of antibiotic stewardship is "the right drug at the right time and the right dose for the right bug for the right duration." A major emphasis was that antibiotic stewardship should be a core competency of critical care clinicians. Fear of pathogens that are not covered by empirical antibiotics is a major driver of excessively broad-spectrum therapy in critically ill patients. Better diagnostics and outcome data can address this fear and expand efforts to narrow or shorten therapy. Greater awareness of the substantial adverse effects of antibiotics should be emphasized and is an important counterargument to broad-spectrum therapy in individual low-risk patients. Optimal antibiotic stewardship should not focus solely on reducing antibiotic use or ensuring compliance with guidelines. Instead, it should enhance care both for individual patients (by improving and individualizing their choice of antibiotic) and for the ICU population as a whole. Opportunities for antibiotic stewardship in common ICU infections, including community-and hospitalacquired pneumonia and sepsis, are discussed. Intensivists can partner with antibiotic stewardship programs to address barriers and improve patient care.

Antibiotic utilization, sensitivity, and cost in the medical intensive care unit of a tertiary care teaching hospital in Nepal

“…In several countries, antibiotic resistance in the ICU setting is emerging as a significant and challenging health problem influencing patient outcomes. 6 – 8 Treatment of bacterial infections such as sepsis, intra-abdominal infections, and meningitis is becoming difficult as bacteria develop resistance to the antibiotics making the treatment less effective. 9 Antibiotic resistance leads to longer hospitalization, increased healthcare cost, decreased therapeutic outcome, and eventually increased mortality.…”

Bronchoscopy on Intubated COVID-19 Patients is Associated with Low Infectious Risk to Operators at a High-Volume Center Using an Aerosol-minimizing Protocol

“…Therefore, an accurate diagnosis of bacterial superinfection of ventilated COVID-19 patients is important for management, especially to guide appropriate antibiotic stewardship (Pickens & Wunderink, 2019; Wunderink et al, 2020). Bronchoalveolar lavage (BAL) with quantitative cultures can be a helpful diagnostic test in the management of severe pneumonia (Torres et al, 2017).…”

Bronchoscopy on Intubated Patients with COVID-19 Is Associated with Low Infectious Risk to Operators

“…Appropriate treatment of bacterial coinfection may therefore improve outcomes ( 4 ). Accurate diagnosis of bacterial superinfection in ventilated patients with COVID-19 is important for appropriate antibiotic stewardship ( 5 , 6 ).…”