Antimicrobial Stewardship in ICU: A Success Story

Antimicrobial resistance (AMR) has emerged as a global crisis. There is evidence of ever-emerging drug-resistant pathogens and very few new antimicrobial agents in development. The ICUs and the critical care setups are known as the epicenters for the development of antimicrobial resistance. One of the most important contributing factors to the development of multidrug-resistant organisms is the overuse and misuse of antibiotics in healthcare facilities. To combat this global crisis of AMR, antimicrobial stewardship (AMS) appears to be one of the major interventions, which appears to mitigate the problem. The goals of AMS are optimizing antibiotic use to limit the emergence of multidrug-resistant organisms (MDROs) and to reduce costs related to unnecessary antimicrobial use. The WHO, CDC, and scientific societies from North America and European countries have recommended guidelines to implement the “antibiotic stewardship program” (ASP) and key elements to establish the ASP. There are significant barriers to implementing the “ASP” in ICUs because of the specific criteria when treating critically ill patients. The barriers which are of concern for the ICUs are uncertainty of diagnosis, lack of rapid laboratory tools to diagnose the causative organism and its resistance pattern, lack of understanding about the antimicrobials and nonacceptance behavior by the ICU physicians, lack of time, lack of electronic medical records and personnel, etc. The ASP team comprises ICU physicians, infectious disease physicians, microbiologists, clinical pharmacists, and infection control practitioners. It led to early administration of the right drug and the right dose for the right duration, incorporating antimicrobial pharmacokinetics and pharmacodynamics (PK/PD) when prescribing antibiotics and de-escalation according to the susceptibility and the optimal duration. Education, audit and feedback, guidelines, and a computerized antibiotic decision support system were identified as facilitators for the successful implementation of the ASP. The ASP implementation was associated with several positive outcomes like reduction of antibiotic use, the downward trend of Clostridium difficile infection incidence rate and costs, and decreased length of stay. Artificial intelligence may have a very important role in the coming days.