Management of antimicrobial use in the intensive care unit

Francisco Álvarez-Lerma, Santiago Grau

Research output: Contribution to journalReview articleResearchpeer-review

19 Citations (Scopus)

Abstract

Critically ill patients admitted to the intensive care unit (ICU) are frequently treated with antimicrobials. The appropriate and judicious use of antimicrobial treatment in the ICU setting is a constant clinical challenge for healthcare staff due to the appearance and spread of new multiresistant pathogens and the need to update knowledge of factors involved in the selection of multiresistance and in the patients clinical response. In order to optimize the efficacy of empirical antibacterial treatments and to reduce the selection of multiresistant pathogens, different strategies have been advocated, including de-escalation therapy and pre-emptive therapy as well as measurement of pharmacokinetic and pharmacodynamic (pKpD) parameters for proper dosing adjustment. Although the theoretical arguments of all these strategies are very attractive, evidence of their effectiveness is scarce. The identification of the concentration-dependent and time-dependent activity pattern of antimicrobials allow the classification of drugs into three groups, each group with its own pKpD characteristics, which are the basis for the identification of new forms of administration of antimicrobials to optimize their efficacy (single dose, loading dose, continuous infusion) and to decrease toxicity. The appearance of new multiresistant pathogens, such as imipenem-resistant Pseudomonas aeruginosa andor Acinetobacter baumannii, carbapenem-resistant Gram-negative bacteria harbouring carbapenemases, and vancomycin-resistant Enterococcus spp., has determined the use of new antibacterials, the reintroduction of other drugs that have been removed in the past due to toxicity or the use of combinations with in vitro synergy. Finally, pharmacoeconomic aspects should be considered for the choice of appropriate antimicrobials in the care of critically ill patients. © 2012 Adis Data Information BV. All rights reserved.
Original languageEnglish
Pages (from-to)447-470
JournalDrugs
Volume72
Issue number4
DOIs
Publication statusPublished - 27 Feb 2012

Keywords

  • Acinetobacter-infections
  • Amikacin
  • Aminoglycosides
  • Antimicrobial-resistance
  • Aspergillosis
  • Azithromycin
  • Aztreonam
  • Beta-lactams
  • Candidiasis
  • Carbapenems
  • Cefpirome
  • Ceftazidime
  • Ceftriaxone
  • Cephalosporins
  • Cilastatin
  • Ciprofloxacin
  • Colistimethate-sodium
  • Colistin
  • Cotrimoxazole
  • Daptomycin
  • Doripenem
  • Doxycycline
  • Ertapenem
  • Fluoroquinolones
  • Fosfomycin
  • Gentamicin
  • Glycylcyclines
  • Gram-negative-infections
  • Healthcare-expenditure
  • Imipenem
  • Intensive-care-units
  • Levofloxacin
  • Linezolid
  • Meropenem
  • Methicillin-resistant-Staphylococcus-aureus- infections
  • Metronidazole
  • Nosocomial-pneumonia
  • Oxacillin
  • Pharmacokinetic- pharmacodynamic-relationships
  • Piperacillin
  • Pseudomonal-infections
  • Quinupristindalfopristin
  • Rifampicin
  • Sepsis
  • Septic-shock
  • Staphylococcal- infections
  • Streptococcal-infections
  • Sulbactamampicillin
  • Tazobactam
  • Teicoplanin
  • Telavancin
  • Tetracycline
  • Tigecycline
  • Vancomycin
  • Vancomycin-resistant- enterococcal-infections
  • Vancomycin-resistant-Staphylococcus-aureus-infections

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