The intensive care medicine research agenda on multidrug-resistant bacteria, antibiotics, and stewardship.
OBJECTIVE
To concisely describe the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to the management of multidrug-resistant (MDR) bacteria, antibiotic use, and antimicrobial stewardship in the intensive care unit (ICU) setting.


METHODS
Narrative review based on a systematic analysis of the medical literature, national and international guidelines, and expert opinion.


RESULTS
The prevalence of infection of critically ill patients by MDR bacteria is rapidly evolving. Clinical studies aimed at improving understanding of the changing patterns of these infections in ICUs are urgently needed. Ideal antibiotic utilization is another area of uncertainty requiring additional investigations aimed at better understanding of dose optimization, duration of therapy, use of combination treatment, aerosolized antibiotics, and the integration of rapid diagnostics as a guide for treatment. Moreover, there is an imperative need to develop non-antibiotic approaches for the prevention and treatment of MDR infections in the ICU. Finally, clinical research aimed at demonstrating the beneficial impact of antimicrobial stewardship in the ICU setting is essential.


CONCLUSIONS
These and other fundamental questions need to be addressed over the next decade in order to better understand how to prevent, diagnose, and treat MDR bacterial infections. Clinical studies described in this research agenda provide a template and set priorities for investigations that should be performed in this field.
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8052, St. Louis, MO, 63110, USA. kollefm@wustl.edu.
Marin H
MH
Kollef
Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
Matteo
M
Bassetti
Service de Réanimation Polyvalente, Inserm CIC-1435, CHU Dupuytren, Limoges, France.
Bruno
B
Francois
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
Jason
J
Burnham
Department of Critical Care, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
George
G
Dimopoulos
Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Seville, Spain.|Institute of Biomedicine of Seville, IBiS/CSIC/University of Seville, Seville, Spain.
Jose
J
Garnacho-Montero
Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia.|Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Herston, Brisbane, QLD, Australia.
Jeffrey
J
Lipman
Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.|Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS 1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
Charles-Edouard
CE
Luyt
Center for Anti-infective Research and Development and Division of Infectious Diseases, Hartford Hospital, Hartford, CT, USA.
David P
DP
Nicolau
Unit of PharmacoTherapy, Epidemiology & Economics, Department of Pharmacy and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Maarten J
MJ
Postma
Department of Pulmonology, Hospital Clinic of Barcelona, CIBERES, IDIBAPS, University of Barcelona, Barcelona, Spain.
Antonio
A
Torres
Department of Pulmonology, Hannover Medical School, Hannover, Germany.
Tobias
T
Welte
Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Richard G
RG
Wunderink
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D000073602:Antimicrobial Stewardship / Q000592:standards*; D035843:Biomedical Research; D003422:Critical Care / Q000379:methods / Q000592:standards*; D016638:Critical Illness / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D017064:Process Assessment, Health Care; D059039:Standard of Care
D000900:Anti-Bacterial Agents
Antibiotics; Bacteria; Multidrug resistance; Stewardship