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Semin Respir Crit Care Med 2022; 43(01): 131-140
DOI: 10.1055/s-0041-1740977
Review Article

Antimicrobial Stewardship in the ICU

Claire V. Murphy
1   Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
,
Erica E. Reed
1   Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
,
Derrick D. Herman
2   Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
,
BrookeAnne Magrum
1   Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
,
Julia J. Beatty
1   Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
,
Kurt B. Stevenson
3   Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
4   Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
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Abstract

Increasing rates of infection and multidrug-resistant pathogens, along with a high use of antimicrobial therapy, make the intensive care unit (ICU) an ideal setting for implementing and supporting antimicrobial stewardship efforts. Overuse of antimicrobial agents is common in the ICU, as practitioners are challenged daily with achieving early, appropriate empiric antimicrobial therapy to improve patient outcomes. While early antimicrobial stewardship programs focused on the financial implications of antimicrobial overuse, current goals of stewardship programs align closely with those of critical care providers—to optimize patient outcomes, reduce development of resistance, and minimize adverse outcomes associated with antibiotic overuse and misuse such as acute kidney injury and Clostridioides difficile-associated disease. Significant opportunities exist in the ICU for critical care clinicians to support stewardship practices at the bedside, including thoughtful and restrained initiation of antimicrobial therapy, use of biomarkers in addition to rapid diagnostics, Staphylococcus aureus screening, and traditional microbiologic culture and susceptibilities to guide antibiotic de-escalation, and use of the shortest duration of therapy that is clinically appropriate. Integration of critical care practitioners into the initiatives of antimicrobial stewardship programs is key to their success. This review summarizes key components of antimicrobial stewardship programs and mechanisms for critical care practitioners to share the responsibility for antimicrobial stewardship.

Keywords

antimicrobial stewardship - biomarkers - critical care - pneumonia - sepsis


Publication History

Article published online:
16 February 2022

© 2022. Thieme. All rights reserved.

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