Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland.
Hospital Clinic, IDIBAPS, Universidad De Barcelona, CIBERES, Barcelona, Spain.
Expert Rev Anti Infect Ther. 2021 Jun;19(6):759-767. doi: 10.1080/14787210.2021.1857730. Epub 2020 Dec 14.
Intensive Care Units (ICU) are among the hospital wards exhibiting the highest prevalence of antimicrobial resistance (AMR), and resulting impact on patient outcomes. Antimicrobial resistance surveillance and antimicrobial stewardship (AMS) programs play a pivotal role in promoting interventions tailored to optimize infection diagnosis and treatment in the final attempt to limit unnecessary antimicrobial use and development of resistance.
A narrative review of the literature was carried out to summarize the available evidence and develop a set of actions that should be considered for integration into the ICU stewardship framework. Four questions were addressed: how AMR surveillance can inform antibiotic policy in ICU; whether pharmacokinetic and pharmacodynamic (PK/PD) principles and the use of procalcitonin should be incorporated as a standard practice in ICU AMS programs to optimize antibiotic treatment and to drive antibiotic discontinuation; which criteria should drive treatment duration of ICU-associated infections.
In this review we aim to highlight that the ICU must be considered in its own right. Each ICU has its own characteristics depending on the country, on the local antibiotic resistance profile, on the patients feature and the severity of infection.
重症监护病房（ICU）是医院病房中出现抗生素耐药性（AMR）最高的病房之一，对患者的预后有重大影响。抗生素耐药性监测和抗生素管理（AMS）计划在促进针对感染诊断和治疗的干预措施方面发挥着关键作用，最终目的是限制不必要的抗生素使用和耐药性的发展。
对文献进行了叙述性综述，以总结现有证据，并制定了一套应考虑纳入 ICU 管理框架的行动。提出了四个问题：抗生素耐药性监测如何为 ICU 中的抗生素政策提供信息；是否应将药代动力学和药效学（PK/PD）原则以及降钙素原的使用纳入 ICU AMS 计划的标准实践，以优化抗生素治疗并推动抗生素停药；哪些标准应决定 ICU 相关性感染的治疗持续时间。
在本次综述中，我们旨在强调必须将 ICU 作为一个整体来考虑。每个 ICU 都有其自身的特点，取决于国家、当地的抗生素耐药情况、患者特征和感染的严重程度。
