Implementing an Antimicrobial Stewardship Program and Complete Screening in an Intensive Care Unit in Relation to the Overall Clinical Outcome of Patients

Abstract

Background The high prevalence of resistant microorganisms indicates a multidisciplinary approach, which will ensure efficiency and balance between resistance therapy of choice and the implementation of an antimicrobial stewardship (AMS) program in intensive unit care (ICU). Objectives The objectives are based on the assessment of AMS in a cardiac surgical intensive care unit (CICU), by determination with the reduction of: inotropic support, length of antibiotic treatment, and need for renal replacement therapy (RRT). Material and methods The research is a retrospective, group comparative, analytical cross-sectional study, in the period from 2020-2023, within the Cardiosurgery department, at Acibadem Sistina. 1277 patients participated in the research, divided into two groups: group 1 (2020-2021) and group 2 (2022-2023). Primary endpoints investigated: inotropic support, need for RRT and length of antibiotic treatment. Secondary endpoints investigated: optimization of antibiotic therapeutic regimen and clinical outcome assessment of patients (survival). Results The inotropic support during 24, 48 and 72 h was statistically significantly lower in group 2. A statistically significant shorter length of time for antibiotic treatment was determined in patients in group 2 (p=0.000), as well as a lower value of the need for RRT. A statistically significant difference in time to event (fatal outcome) was determined between the two groups (p=0.000). A significant difference (p=0.000) was determined in the prescription and optimization of the therapeutic regimen. Conclusion Integrating AMS, initial comprehensive microbiological screening and application of biomarkers in the CICU, established appropriately, will result in improved overall clinical outcome for patients.