Optimizing antimicrobial therapy in critically ill patients

Figures & data

Table 1 Summary of main studies on ASPs in ICUs

Authors	Study design	Strategy/procedure	Study results
Slain et al^Citation92	Pre-/post-intervention Observational study ICU	Multimodal ASP	– Reduction of intravenous ciprofloxacin use and ceftazidime – Transitory decrease in Pseudomonas aeruginosa resistance
Carling et al^Citation88	Pre-/post-intervention (7 yrs) Observational study All units	Multimodal ASP	– Significant decrease of parenteral broad-spectrum antibiotics – Decrease in nosocomial infections by Clostridium difficile or resistant Enterobacteriaceae – No impact on VRE and MRSA prevalence
Katsios et al^Citation93	Pre-/post-intervention Observational study ICU 269 patients	Multimodal ASP	– Microbiologically-targeted therapy (treatment of positive sterile sites > non-sterile sites) – Reduction in cost and DDDs
Rimawi et al^Citation102	Pre-/post-intervention Observational study ICU 246 patients	Education, prescription review	– Significant reduction in extended-spectrum antibiotics, carbapenem, vancomycin, metronidazole – Better adherence to guidelines – Reduction in mechanical ventilation days, length of stay, and costs – Reduction in mortality
Kim et al^Citation96	Open-label randomized Monocentric ICU 109 patients	De-escalation in VAP	– No statistical difference in length of stay, 14-day and 28-day mortality – Multivariate analysis: emergence of MRSA was significantly higher in de-escalation group vs non de-escalation group
Garnacho-Montero et al^Citation97	Prospective observational study in ICU 628 patients	De-escalation	– Reduction in hospital mortality and 90-day mortality
Ng et al^Citation91	Pre-/post-intervention Observational study All units	Antibiotic restriction	– Decrease in restricted and non-restricted antibiotic consumption
Gentry et al^Citation94	Pre-/post-intervention Observational study ICU	Antibiotic restriction	– Reduced length of stay – No difference in mortality rate
Rahal et al^Citation95	Pre-/post-intervention Observational study ICU All units sub-study	Antibiotic restriction	– Significant decrease in resistant Klebsiella spp. – Increase in imipenem use and incidence of imipenem-resistant P. aeruginosa
Jain et al^Citation103	Pre-/post-intervention 196 ICUs 2 million patients	Barrier precautions	– Decrease in infections caused by MRSA and other pathogens
Huskins et al^Citation104	18 ICUs 9,000 patients	Barrier precautions	– No effect on colonization or infection rates
Huang et al^Citation105	All units 501 patients	Multimodal ASP combined with MALDI-TOF-MS	– Improved time to effective and optimal antibiotic therapy – Decreased mortality, length of stay in ICU, and recurrent bacteremia

Note: Study results in bold type represent the only studies showing a decrease in mortality as the major outcome indicator.

Abbreviations: ASP, antimicrobial stewardship program; ICU, intensive care unit; yrs, years; VAP, ventilator-associated pneumonia; MALDI-TOF-MS, matrix-assisted laser desorption ionization time-of-flight mass spectrometry; VRE, vancomycin-resistant enterococci; MRSA, methicillin-resistant Staphylococcus aureus; DDDs, defined daily doses; vs, versus.

SlainDSarwariARPetrosKOImpact of a multimodal antimicrobial stewardship program on Pseudomonas aeruginosa susceptibility and antimicrobial use in the intensive care unit settingCrit Care Res Pract2011201141642621687626

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CarlingPFungTKillionATerrinNBarzaMFavorable impact of a multidisciplinary antibiotic management program conducted during 7 yearsInfect Control Hosp Epidemiol200324969970614510254

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KatsiosCMBurryLNelsonSAn antimicrobial stewardship program improves antimicrobial treatment by culture site and the quality of antimicrobial prescribing in critically ill patientsCrit Care201216R21623127353

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RimawiRHMazerMASirajDSGoochMCookPPImpact of regular collaboration between infectious diseases and critical care practitioners on antimicrobial utilization and patient outcomeCrit Care Med20134192099210723873275

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KimJWChungJChoiSHEarly use of imipenem/cilastatin and vancomycin followed by de-escalation versus conventional antimicrobials without de-escalation for patients with hospital-acquired pneumonia in a medical ICU: a randomized clinical trialCrit Care2012161R2822336530

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Garnacho-MonteroJGutiérrez-PizarrayaAEscoresca-OrtegaADe-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shockIntensive Care Med2014401324024026297

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NgCKWuTCChanWMClinical and economic impact of an antibiotics stewardship programme in a regional hospital in Hong KongQual Saf Health Care200817538739218842981

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GentryCAGreenfieldRASlaterLNWackMHuyckeMMOutcomes of an antimicrobial control program in a teaching hospitalAm J Health Syst Pharm200057326827410674779

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RahalJJUrbanCHornDClass restriction of cephalosporin use to control total cephalosporin resistance in nosocomial KlebsiellaJAMA199828014123312379786372

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JainRKralovicSMEvansMEVeterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infectionsN Engl J Med2011364151419143021488764

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HuskinsWCHuckabeeCMO’GradyNPSTAR*ICU Trial InvestigatorsIntervention to reduce transmission of resistant bacteria in intensive careN Engl J Med2011364151407141821488763

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HuangAMNewtonDKunapuliAImpact of rapid organism identification via matrix-assisted laser desorption/ionization time-of-flight combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemiaClin Infect Dis20135791237124523899684

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