Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric)

Abstract

Emerging resistance to antibiotics shows no signs of decline. At the same time, few new antibacterials are being discovered. There is a worldwide recognition regarding the danger of this situation. The urgency of the situation and the conviction that practices should change led the Société de Réanimation de Langue Française (SRLF) and the Société Française d'Anesthésie et de Réanimation (SFAR) to set up a panel of experts from various disciplines. These experts met for the first time at the end of 2012 and have since met regularly to issue the following 67 recommendations, according to the rigorous GRADE methodology. Five fields were explored: i) the link between the resistance of bacteria and the use of antibiotics in intensive care; ii) which microbiological data and how to use them to reduce antibiotic consumption; iii) how should antibiotic therapy be chosen to limit consumption of antibiotics; iv) how can antibiotic administration be optimized; v) review and duration of antibiotic treatments. In each institution, the appropriation of these recommendations should arouse multidisciplinary discussions resulting in better knowledge of local epidemiology, rate of antibiotic use, and finally protocols for improving the stewardship of antibiotics. These efforts should contribute to limit the emergence of resistant bacteria.

Are third-generation cephalosporins unavoidable for empirical therapy of community-acquired pneumonia in adult patients who require ICU admission? A retrospective study

“…Gram-positive diplococci or numerous Gram-negative bacilli) might modify the choice of definitive therapy. In general, fluoroquinolones use was discouraged except in case of confirmed severe legionellosis [15]. …”

Evaluation of early antimicrobial therapy adaptation guided by the BetaLACTA® test: a case-control study

“…This in turn favours the emergence of carbapenemase-producing Enterobacteriaceae [5]. To minimize the individual risk of an inappropriate EAT and at the same time the societal risk of excessive broad-spectrum beta-lactams consumption, early initiation of broad-spectrum EAT is recommended, followed by its de-escalation as soon as the results of antibiotic susceptibility tests (AST) are available [6, 7]. However, this conventional AST-guided de-escalation occurs 48 to 72 hours after initiation of EAT [8].…”

Focus on immunocompromised patients

“…All these data allowed the appraisal of the current epidemiology of infections in immunocompromised patients, and the safe performing of antibiotic de-escalation in patients with neutropenia [7,8]. This strategy, which consists of "de-escalating antimicrobial therapy" by either reducing the number or the spectrum of the molecule used is now part of recently published guidelines [9]. If Mokart and Paskovaty provided convincing retrospective data making a substantial background for the feasibility and the safety of this intervention, dedicated trials are, nevertheless, warranted before drawing any definite conclusion.…”