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Antibiotic stewardship in the intensive care unit: Challenges and opportunities

Published online by Cambridge University Press:  03 May 2019

Kathleen Chiotos ,
Pranita D. Tamma  and
Jeffrey S. Gerber Open the ORCID record for Jeffrey S. Gerber [Opens in a new window]
Kathleen Chiotos
Affiliation:
Division of Critical Care Medicine, Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA
Pranita D. Tamma
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Jeffrey S. Gerber*
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA
*
Author for correspondence: Jeffrey S. Gerber, E-mail: gerberj@email.chop.edu
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Abstract

Infections due to antibiotic-resistant organisms are increasing in prevalence and represent a major public health threat. Antibiotic overuse is a major driver of this epidemic, and antibiotic stewardship an important means of limiting antibiotic resistance. The intensive care unit (ICU) setting presents an intersection of opportunities and challenges for effective antibiotic stewardship, but limited data inform optimal stewardship interventions in this setting. In this review, we present unique considerations for stewardship interventions the ICU setting and summarize available data evaluating the impact of prospective audit and feedback, diagnostic test stewardship, rapid molecular diagnostic tests, and procalcitonin-guided algorithms for antibiotic discontinuation. The existing knowledge gaps ripe for future research are emphasized.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 6 , June 2019 , pp. 693 - 698
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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