The effect of limiting antimicrobial therapy duration on antimicrobial resistance in the critical care setting

Discontinuation of antimicrobials and costs of treating patients with infection

“…With respect to antimicrobial treatment, it is emphasized that the use of broad-spectrum ATB in empirical therapy is associated with lower rates of mortality among critically ill patients (8)(9) . For this reason, the guidelines for treatment of HCAI recommends that patients who have risk factors for infections caused by resistant microorganisms receive empirical therapy with at least two broad-spectrum antimicrobial (8,(10)(11)(12) .…”

“…Among them, we can cite the de-escalation, ie the adjustment for the most appropriate antibiotic, as soon as the culture results were available, auditing of antimicrobials, as well as the restriction of some drugs, their use were released only after prior authorization of the HICC medical auditors. Such measurements are reported in the literature to be essential for the containment of bacterial resistance with respect to the proper management of antimicrobials (9,13) . Thus, the choice of empirical treatment should be based on the time of onset of infection, previous use of antibiotics, prolonged use of invasive procedures, the patient's advanced age (over 65), previous hospitalizations, presence of colonization and especially knowledge of the prevalence of microbial agents frequently in the institution (11,12,15,16) .…”

“…Nevertheless, in the hospital environment, specifically in the Intensive Care Units (ICU), the occurrence of Healthcare Associated Infections (HCAI) due to microorganisms resistance has become increasingly common (6,7) . Based on this fact and on the premise that receiving appropriate treatment within 24 hours after the diagnosis of HCAI is fundamental to a more favorable outcome for the patient, it is observed an increasing use of broad-spectrum antibiotics action in the empirical treatment (one that occurs before microbiological confirmation of the infection causative agent and resistance profile (8,9) . This practice has been endorsed by the main agencies and international and national health societies, aiming to try to reduce patient complications and consequently mortality rates (8)(9)(10)(11)(12) .…”

“…Based on this fact and on the premise that receiving appropriate treatment within 24 hours after the diagnosis of HCAI is fundamental to a more favorable outcome for the patient, it is observed an increasing use of broad-spectrum antibiotics action in the empirical treatment (one that occurs before microbiological confirmation of the infection causative agent and resistance profile (8,9) . This practice has been endorsed by the main agencies and international and national health societies, aiming to try to reduce patient complications and consequently mortality rates (8)(9)(10)(11)(12) . However, due to the possibility of selecting resistant bacteria to broad-spectrum ATB used in the empirical treatment, some strategies have been used in order to ease the consequences of the action use of broad-spectrum antibiotics.…”

“…However, due to the possibility of selecting resistant bacteria to broad-spectrum ATB used in the empirical treatment, some strategies have been used in order to ease the consequences of the action use of broad-spectrum antibiotics. Among them, one can cite the de-escalation, ie adjusting for the most appropriate antibiotic once the culture results is available, the audit of antimicrobials, as well as the restriction of some drugs, with its use released only after prior approval of the medical auditors of the Hospital Infection Control Committee (HICC) (9) .…”