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Med. Sci. 2018, 6(2), 40; https://doi.org/10.3390/medsci6020040

Feasibility of Antimicrobial Stewardship (AMS) in Critical Care Settings: A Multidisciplinary Approach Strategy

1
Department of Anaesthesia and Critical Care Medicine, St James’s Hospital, P.O. Box 580 Dublin 8, Ireland
2
Fundacao Oswaldo Cruz, Rio de Janeiro, RJ 37903, Brazil
3
Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital, P.O. Box 580 Dublin 8, Ireland
4
Trinity Centre for Health Sciences, P.O. Box 580 Dublin 8, Ireland
5
CIBER enfermedades respiratorias, 28029 Madrid, Spain
*
Author to whom correspondence should be addressed.
Received: 11 March 2018 / Revised: 16 May 2018 / Accepted: 16 May 2018 / Published: 25 May 2018
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Abstract

Antimicrobial resistance is escalating and triggers clinical decision-making challenges when treating infections in patients admitted to intensive care units (ICU). Antimicrobial stewardship (AMS) may help combat this problem, but it can be difficult to implement in critical care settings. The implementation of multidisciplinary AMS in ICUs could be more challenging than what is currently suggested in the literature. Our main goal was to analyze the reduction in duration of treatment (DOT) for the most commonly used antibacterial and antifungal agents during the first six months of 2014, and during the same period two years later (2016). A total of 426 and 424 patient encounters, respectively, were documented and collected from the intensive care unit’s electronic patient record system. Daily multidisciplinary ward rounds were conducted for approximately 30–40 min, with the goal of optimizing antimicrobial therapy in order to analyze the feasibility of implementing AMS. The only antimicrobial agent which showed a significant reduction in the number of prescriptions and in the duration of treatment during the second audit was vancomycin, while linezolid showed an increase in the number of prescriptions with no significant prolongation of the duration of treatment. A trend of reduction was also seen in the DOT for co-amoxiclavulanate and in the number of prescriptions of anidulafungin without any corresponding increases being observed for other broad-spectrum anti-infective agents (p-values of 0.07 and 0.05, respectively). View Full-Text
Keywords: resistance; antimicrobial stewardship (AMS); pneumonia; sepsis; ventilator-associated pneumonia (VAP); intensive care unit (ICU); multidrug resistance (MDR); stewardship; antibiotics resistance; antimicrobial stewardship (AMS); pneumonia; sepsis; ventilator-associated pneumonia (VAP); intensive care unit (ICU); multidrug resistance (MDR); stewardship; antibiotics
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Tiszai-Szucs, T.; Mac Sweeney, C.; Keaveny, J.; Bozza, F.A.; O. Hagan, Z.; Martin-Loeches, I. Feasibility of Antimicrobial Stewardship (AMS) in Critical Care Settings: A Multidisciplinary Approach Strategy. Med. Sci. 2018, 6, 40.

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