Rational use of antibiotics in the intensive care unit: impact on microbial resistance and costs

Geißler, A.; Gerbeaux, Patrick; Granier, I.; Blanc, P; Facon, K; Durand-Gasselin, Jacques

doi:10.1007/s00134-002-1565-2

Cited by 92 publications

(56 citation statements)

References 25 publications

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“…These components include audits [57] , infectious disease specialist or senior clinician input [58][59][60][61][62][63][64] , or planned discontinuation/deescalation of treatment in response to clinical and microbiological outcome data [65] . Other components include rotating antibiotic schedules [57,[66][67][68][69][70] changes in prescribing policies involving antibiotic restriction, different dosing regimens or prophylaxis protocols [57,62,65,67,[71][72][73][74][75][76][77][78][79][80][81][82][83][84] and a multi-disciplinary team (MDT) approach in treatment initiation and discontinuation, often emphasising feedback and non-punitive atmosphere among staff members [83,85] . Some programmes also encompassed staff education [57,74,76] and computerised decision support platforms [86][87][88][89][90][91] .…”

Section: Discussionmentioning

confidence: 99%

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Zhang

Singh

2015

WJCCM

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Antibiotic usage and increasing antimicrobial resistance (AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units (ICU). Antibiotic stewardship programmes (ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies" through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial (RCT), 22 observational and 11 case series], 29 (85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin (PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop (de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.

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Section: Discussionmentioning

confidence: 99%

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Zhang

Singh

2015

WJCCM

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“…Por otra parte, se debe estimular la vigilancia activa del consumo de antibióticos como una medida adicional para la vigilancia y control de la RA. Algunas estrategias de restricción de la prescripción de antibióticos, especialmente en UCI, han demostrado ser capaces además de disminuir el grado de RA, disminuir costos de la atención, tanto en países desarrollados con en vías de desarrollo (38,39). Estas estrategias, sumadas a un mejoramiento en las medidas de control de infección deben ser recomendadas en nuestros hospitales como una de las medidas para el control de la RA.…”

Section: Discussionunclassified

Resistencia Antimicrobiana en Unidades de Cuidado Intensivo de Bogotá, Colombia, 2001-2003

Álvarez¹,

Cortés²,

Arango

et al. 2006

Rev. salud pública

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“…In studies evaluating two or more different periods, confounding variables can interfere with the results. (13) Such confounding variables include changes in medical and nursing staff, in the quality of invasive procedures, in the profile of in-hospital patients, in measures for prevention and control of cross infections, in the level of resistance of microorganisms, and in policies regarding the use of antimicrobial agents. Predisposing factors for pneumonia (age, comorbidities, MV, nasogastric tube, and drugs that change the gastric pH), as well as innovations in surgical techniques, can also be considered confounding variables.…”

Section: Discussionmentioning

confidence: 99%

Impacto da implantação de um guia terapêutico para o tratamento de pneumonia nosocomial adquirida na unidade de terapia intensiva em hospital universitário

et al. 2007

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Objective: To evaluate the impact that the implementation of therapeutic guidelines has on the empirical treatment of nosocomial pneumonia. Methods: A clinical trial, using historical controls and involving current ICU patients who had acquired nosocomial pneumonia, was carried out from June of 2002 to June of 2003. All were treated according to therapeutic guidelines developed by the Commission for Nosocomial Infection Control of the institution (group with intervention). As controls, the medical charts of the patients who acquired nosocomial pneumonia between June of 2000 and June of 2001 (group without intervention) were analyzed. Mortality and mean treatment period, as well as the length of hospital and ICU stays, were determined for the patients who acquired nosocomial pneumonia. Results: Mortality associated with pneumonia was lower in the group treated according to the therapeutic guidelines (26 vs. 53.6%; p = 0.00). As for overall mortality, there was no statistically significant difference between the two periods (51 vs. 57.9%; p = 0.37). There was also no difference in the type of microorganisms isolated, treatment period, length of hospital stay or length of ICU stay. Conclusion: The implementation of therapeutic guidelines for the treatment of nosocomial pneumonia acquired in the ICU can be efficacious in decreasing mortality rates.

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Rational use of antibiotics in the intensive care unit: impact on microbial resistance and costs

Abstract: Antibiotic-use policy allowed a reduction in antibiotic-selective pressure, costs linked to antibiotics and selective reduction of nosocomial infections due to antimicrobial resistant micro-organisms.

Cited by 92 publications

References 25 publications

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Resistencia Antimicrobiana en Unidades de Cuidado Intensivo de Bogotá, Colombia, 2001-2003

Impacto da implantação de um guia terapêutico para o tratamento de pneumonia nosocomial adquirida na unidade de terapia intensiva em hospital universitário

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