Abstract
Patients with severe infections are often treated with multiple courses of antibiotics
in the intensive care unit (ICU), making the ICU a true antibiotic hotspot. The increasing
incidence of multidrug resistance worldwide emphasizes the need for continued efforts
in developing and implementing antibiotic stewardship programs. Using a pragmatic
approach for the bedside clinical team, this review will highlight different key moments
for antibiotic decision making throughout the course of the antibiotic treatment in
patients with severe infections. We will focus especially on the importance of adequate
empirical therapy, source control in infections, assessment of immune status, and
two separate antibiotic time-out moments early in the course, as well as the moment
of stopping antibiotics. Additionally, the importance of a team-based approach and
clinical decision support systems will be highlighted.
Keywords
antibiotic stewardship - clinical decision support systems - empirical therapy - critical
illness - severe infections
