Antimicrobial Stewardship: There's No Such Thing as Too Much

Hand Hygiene, and Not Ertapenem Use, Contributed to Reduction of Carbapenem-Resistant Pseudomonas aeruginosa Rates

“…Time-series segmented regression analysis was used to determine significant changes in the level and trend of antibiotic use and resistance patterns throughout the study periods. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] By this analysis, estimates of changes in level (immediate change after intervention) and trend (changes that occurred after months of intervention) were determined.…”

“…As Pagani stated, in reference to antimicrobial stewardship programs, "there is no such thing as too much." 8 We would like to add, to control resistance, too much is not enough, and efforts must go beyond the use of antimicrobial stewardship programs.…”

“…[3][4][5][6][7] Factors other than antimicrobial consumption may contribute to the rise of re-sistance, and infection control programs must address all of these issues in order to control for the emergence of resistance. 8 We evaluated the use of ertapenem and the rates of carbapenem-resistant P. aeruginosa infection in a universityaffiliated hospital, taking into account the volume of antimicrobials consumed, the volume of alcohol-based hand gel consumed, and the density rate of invasive practices.…”

Antibiotic stewardship in the intensive care unit: tools for de-escalation from the American Thoracic Society Meeting 2016

“…Unfortunately the process of deescalating antibiotic regimens in such a manner that is both safe and beneficial to the recovering septic patient has not been well studied. Besides the need for more rigorous data to support the use of rapid diagnostics, other factors may be equally important in developing antibiotic de-escalation strategies including: the formation of multidisciplinary antimicrobial stewardship teams (pharmacy, infectious disease and critical care specialists); the development of ICU dedicated antibiograms; and the use of electronic medical record decision support software (12). As the impact of these initiatives is evaluated in the coming years, critical care physicians will be tasked with leading the movement towards rational, evidence-based de-escalation strategies starting in the ICU.…”