Antimicrobial Stewardship Approaches in the Intensive Care Unit

作者：Doernberg Sarah B^*; Chambers Henry F

来源：Infectious Disease Clinics of North America, 2017, 31(3): 513-+.

DOI：10.1016/j.idc.2017.05.002

• Antimicrobial stewardship
• Antibacterial resistance
• Rapid diagnostics
• Clostridium difficile infection
• Prospective audit and feedback
• Formulary restriction
• Computerized decision support

Antimicrobial stewardship programs aim to monitor, improve, and measure responsible antibiotic use. The intensive care unit (ICU), with its critically ill patients and prevalence of multiple drug-resistant pathogens, presents unique challenges. This article reviews approaches to stewardship with application to the ICU, including the value of diagnostics, principles of empirical and definitive therapy, and measures of effectiveness. There is good evidence that antimicrobial stewardship results in more appropriate antimicrobial use, shorter therapy durations, and lower resistance rates. Data demonstrating hard clinical outcomes, such as adverse events and mortality, are more limited but encouraging; further studies are needed.

• 出版日期2017-9