Antimicrobial stewardship in the intensive care unit: advances and obstacles.
Antimicrobial stewardship involves a multifaceted approach that strives to combat the emergence of resistance, improve clinical outcomes, and control costs by improving antimicrobial use. Therefore, stewardship is of great importance and relevance in the intensive care unit. Clinical decision support systems, biomarker-derived treatment algorithms, and improved knowledge regarding the different components of antimicrobial therapy represent some of the advances that have been made in stewardship. Yet, significant obstacles have prevented the full achievement of stewardship's goals, and approaches to confronting these obstacles should be appreciated. Clinicians should realize that antimicrobials are important therapeutic agents and strive to use them wisely.
Lawrence
Kevin L
KL
Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri 63110, USA.
Kollef
Marin H
MH
D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D004269:DNA, Bacterial / Q000302:isolation & purification; D020000:Decision Support Systems, Clinical; D024881:Drug Resistance, Bacterial; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D010818:Practice Patterns, Physicians'; D011498:Protein Precursors / Q000097:blood
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D004269:DNA, Bacterial; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein