The recent advances and emerging perspectives
The presence of multidrug-resistant bacteria (MDRB) is a challenging problem in ICU. This narrative review, based on recent literature search, summarises the recent advances and emerging perspectives for the optimisation of antibiotic therapy in the ICU.
STUDY STRENGTHS & LIMITATIONS
This paper mainly discusses:
- The risk factors and the current resistance rates in major pathogens responsible for hospital and ICU infections
- When to start or not to start the empiric antimicrobial therapy considering the host response, the immune status of the patients, the biomarker kinetics
- The importance of an early antimicrobial diagnosis to rapidly switch from an empirical to an adequate therapy
- The key features in terms of minimum inhibitory concentration and therapeutic drug monitoring to guide and to evaluate the right therapeutic dose
- The indications and doses of new and long-established antibiotics for treating MDR bacteria
- The risk/benefit of a single drug vs combination therapy and of continuous vs intermittent antibiotic administration
- The importance of the de-escalation strategy in the clinical practice.
- The urgent need of an antibiotic stewardship programme in the ICU to reduce the incidence of colonisation and infections with MDRB.
TAKE HOME MESSAGE
The empirical antimicrobial therapy in ICU should be optimised by taking into account several key aspects, such as the rapid microbiologic diagnosis, the minimum inhibitory concentration and therapeutic drug monitoring of the different drugs, the benefit of single vs combination-drugs therapy.
The de-escalation of the antimicrobial therapy should be implemented in ICU, even if no clear consensus exists.
The antimicrobial stewardship should be implemented in ICU by identifying a structural and executive plan to improve the management of the infected patients.
This article review was prepared and submitted by Professor Maria Vargas, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples (Italy) on behalf of the ESICM Journal Review Club.
1) Torres A. et al, International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia. Eur Respir J. 2017 Sep.