ABSTRACT

Introduction

Intensive Care Units (ICU) are among the hospital wards exhibiting the highest prevalence of antimicrobial resistance (AMR), and resulting impact on patient outcomes. Antimicrobial resistance surveillance and antimicrobial stewardship (AMS) programs play a pivotal role in promoting interventions tailored to optimize infection diagnosis and treatment in the final attempt to limit unnecessary antimicrobial use and development of resistance.

Areas covered

A narrative review of the literature was carried out to summarize the available evidence and develop a set of actions that should be considered for integration into the ICU stewardship framework. Four questions were addressed: how AMR surveillance can inform antibiotic policy in ICU; whether pharmacokinetic and pharmacodynamic (PK/PD) principles and the use of procalcitonin should be incorporated as a standard practice in ICU AMS programs to optimize antibiotic treatment and to drive antibiotic discontinuation; which criteria should drive treatment duration of ICU-associated infections.

Expert opinion

In this review we aim to highlight that the ICU must be considered in its own right. Each ICU has its own characteristics depending on the country, on the local antibiotic resistance profile, on the patients feature and the severity of infection.

中文翻译：

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实施多学科方法治疗危重患者院内感染的策略

摘要

介绍

重症监护病房 (ICU) 是抗菌素耐药性 (AMR) 流行率最高的医院病房之一，并由此对患者预后产生影响。抗菌素耐药性监测和抗菌药物管理 (AMS) 计划在促进为优化感染诊断和治疗而量身定制的干预措施方面发挥着关键作用，最终试图限制不必要的抗菌素使用和耐药性的发展。

覆盖区域

对文献进行了叙述性审查，以总结现有证据并制定一套应考虑纳入 ICU 管理框架的行动。解决了四个问题：AMR 监测如何为 ICU 的抗生素政策提供信息；是否应将药代动力学和药效学 (PK/PD) 原则以及降钙素原的使用作为标准做法纳入 ICU AMS 计划，以优化抗生素治疗并促使停用抗生素；哪些标准应该决定ICU相关感染的治疗持续时间。

专家意见

在这篇综述中，我们旨在强调必须独立考虑 ICU。每个 ICU 都有自己的特点，具体取决于国家、当地抗生素耐药性、患者特征和感染严重程度。