title: Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric).
abstract: Emerging resistance to antibiotics shows no signs of decline. At the same time, few new antibacterials are being discovered. There is a worldwide recognition regarding the danger of this situation. The urgency of the situation and the conviction that practices should change led the Société de Réanimation de Langue Française (SRLF) and the Société Française d'Anesthésie et de Réanimation (SFAR) to set up a panel of experts from various disciplines. These experts met for the first time at the end of 2012 and have since met regularly to issue the following 67 recommendations, according to the rigorous GRADE methodology. Five fields were explored: i) the link between the resistance of bacteria and the use of antibiotics in intensive care; ii) which microbiological data and how to use them to reduce antibiotic consumption; iii) how should antibiotic therapy be chosen to limit consumption of antibiotics; iv) how can antibiotic administration be optimized; v) review and duration of antibiotic treatments. In each institution, the appropriation of these recommendations should arouse multidisciplinary discussions resulting in better knowledge of local epidemiology, rate of antibiotic use, and finally protocols for improving the stewardship of antibiotics. These efforts should contribute to limit the emergence of resistant bacteria.
authors.affiliation: Réanimation Médicale Polyvalente, Pôle Hospitalo-Universitaire 3, CHU-Immeuble Jean Monnet, 44093, Nantes, France, cedric.bretonniere@chu-nantes.fr.
authors.forename: Cédric
authors.initials: C
authors.lastname: Bretonnière
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
authors.forename: Christophe
authors.initials: C
authors.lastname: Milési
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
authors.forename: Laurence
authors.initials: L
authors.lastname: Armand-Lefevre
authors.forename: Olivier
authors.initials: O
authors.lastname: Baldesi
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.forename: Dominique
authors.initials: D
authors.lastname: Decré
authors.forename: Samy
authors.initials: S
authors.lastname: Figueiredo
authors.forename: Rémy
authors.initials: R
authors.lastname: Gauzit
authors.forename: Benoît
authors.initials: B
authors.lastname: Guery
authors.forename: Nicolas
authors.initials: N
authors.lastname: Joram
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.forename: Sigismond
authors.initials: S
authors.lastname: Lasocki
authors.forename: Alain
authors.initials: A
authors.lastname: Lepape
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lesage
authors.forename: Olivier
authors.initials: O
authors.lastname: Pajot
authors.forename: François
authors.initials: F
authors.lastname: Philippart
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Renaud
authors.initials: R
authors.lastname: Vialet
authors.forename: Jean Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Benoît
authors.initials: B
authors.lastname: Misset
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bedos
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy*; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy; D016903:Drug Monitoring; D004352:Drug Resistance, Microbial; D006801:Humans; D007362:Intensive Care Units; D015278:Intensive Care Units, Pediatric; D019564:Unnecessary Procedures
chemical_list: D000900:Anti-Bacterial Agents