Antimicrobial stewardship: application in the intensive care unit.
Critical-care units can be barometers for appropriate antimicrobial use. There, life and death hang on empirical antimicrobial therapy for treatment of infectious diseases. With increasing therapeutic empiricism, triple-drug, broad-spectrum regimens are often necessary, but cannot be continued without fear of the double-edged sword: a life-saving intervention or loss of life following Clostridium difficile infection, infection from a resistant organism, nephrotoxicity, cardiac toxicity, and so on. While broadened initial empirical therapy is considered a standard, it must be necessary, dosed according to pharmacokinetic-pharmacodynamic principles, and stopped when no longer needed. Antimicrobial stewardship interventions shepherd these considerations in antimicrobial therapy. With pharmacists and physicians trained in infectious disease and critical care, clear-cut interventions can be focused on beginning or growing a stewardship program, or proposing future studies.
Owens
Robert C
RC
Department of Clinical Pharmacy Services and Division of Infectious Diseases, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA. owensr@mmc.org
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects*; D001424:Bacterial Infections / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units; D016134:Organizational Policy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents