Impact of Antimicrobial Stewardship Programs on Patient Care in the ICU

By the bioMérieux Connection Editors

Following their introduction over half a century ago, Intensive Care Units (ICUs) have played an invaluable role in caring for patients who are critically ill or seriously injured. However, infections are a common problem in the ICU, resulting in the frequent and sometimes overuse of life-saving antibiotics in those settings. While antimicrobial resistance (AMR) is a process that naturally occurs over time, it is important to note that the overuse and misuse of antibiotics, even when utilized in intensive care environments, is contributing to the further emergence of resistant pathogens.

Frequent Antibiotic Use in Critical Care Settings

The prompt use of antibiotic treatment can mean the difference between life or death, especially in extreme cases. Sepsis, for example, is a life-threatening illness that is common in the ICU. When dealing with conditions like sepsis, it is critical to administer empiric antibiotic therapy to the patient as soon as possible to decrease the likelihood of morbidity. Infections that are urgent and serious threats for ICUs include pathogens such as Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBLs), carbapenem-resistant Enterobacteriaceae (CRE), MDR-Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA).

Antibiotic overuse is common in healthcare settings around the world. In ICUs alone, data indicates that 41-85% of ICU patients are prescribed at least one course of antibiotics during treatment. Antibiotic consumption is estimated to be 10 times higher in ICUs when compared to other care environments. In addition to the treatment of infections, the substantial increase in antibiotic utilization in these settings can be attributed to antibiotics also prescribed as perioperative prophylaxis to prevent or limit major infections in patients who are critically ill.  

Clinicians and intensive care support teams must ensure that antibiotic use is appropriate and optimized to outweigh the negative side effects antibiotics may bring to the patient, as well as contribution to the AMR pandemic. While antibiotic treatment may be necessary in many cases, the unnecessary or suboptimal use of antibiotics can come with serious implications, such as an increase in mortality, a longer length of hospital stay, and an increase in healthcare costs. Data suggests that of ICU patients treated with antibiotics, 30-60% of them are treated with unnecessary, inappropriate, or suboptimal antimicrobials.

Study Shows AMS Improves Quality of Care

Without widespread intervention, antibiotic resistant pathogens will continue to emerge, making it more difficult to treat these infections. Intensive care and infectious disease specialists from organizations such as the European Society of Intensive Care Medicine, and the World Alliance Against Antimicrobial Resistance, have called for increased awareness and action to reduce AMR development in high-risk patient populations such as those in intensive care.

Initiatives such as antimicrobial stewardship (AMS) are encouraged in many healthcare settings to support the optimized use of antimicrobials. Stewardship programs often prioritize the five Ds of stewardship: right diagnosis, right drug, right dose, right duration, and de-escalation. A recent antimicrobial stewardship study conducted in an ICU setting (Do antimicrobial stewardship programs improve the quality of care in ICU patients diagnosed with infectious diseases following consultation? Experience in a tertiary care hospital) suggests that the implementation of AMS programs not only assists the fight against AMR, but they also assist clinicians in providing better patient care.

The study, which included 150 patients diagnosed with sepsis/septic shock or Ventilator Associated Pneumonia (VAP), demonstrated the importance of AMS programs and their ability to reduce the unnecessary use of broad-spectrum antibiotics, slow the development of resistant pathogens. Findings also conclude that stewardship by means of ordering diagnostic tests and procedures to confirm an accurate diagnosis significantly increased patient quality-care scores.

ASPs have been shown to be beneficial in many facets of patient care including reductions in antibiotic costs. If necessary, an ASP can be implemented without an ID specialist in limited resource settings; however, the authors note, “[T]he implementation of ASPs (Antimicrobial Stewardship Programs) in centers where antimicrobial management of ICU patients is largely controlled by infectious diseases specialists, remains a feasible strategy that leads to better patient care.”

Optimizing the use of antibiotics through AMS is an essential part of combatting AMR and protecting patient health and safety. In critically ill populations such as those under close supervision in the ICU, it is especially important to ensure the right course of antimicrobial therapy at the right time. Such actions not only help prevent the spread and emergence of resistant pathogens, but also can possibly improve the standard of care for patients and potentially support better clinical outcomes.

Opinions expressed in this article are not necessarily those of bioMérieux, Inc.

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