Abstract
BackgroundSevere infections and multidrug-resistant pathogens are common in critically ill patients. Antimicrobial stewardship (AMS) and therapeutic drug monitoring (TDM) are contemporary tools to optimize the use of antimicrobials. The A-TEAMICU survey was initiated to gain contemporary insights into dissemination and structure of AMS programs and TDM practices in intensive care units.MethodsThis study involved online survey of members of ESICM and six national professional intensive care societies.ResultsData of 812 respondents from mostly European high- and middle-income countries were available for analysis. 63% had AMS rounds available in their ICU, where 78% performed rounds weekly or more often. While 82% had local guidelines for treatment of infections, only 70% had cumulative antimicrobial susceptibility reports and 56% monitored the quantity of antimicrobials administered. A restriction of antimicrobials was reported by 62%. TDM of antimicrobial agents was used in 61% of ICUs, mostly glycopeptides (89%), aminoglycosides (77%), carbapenems (32%), penicillins (30%), azole antifungals (27%), cephalosporins (17%), and linezolid (16%). 76% of respondents used prolonged/continuous infusion of antimicrobials. The availability of an AMS had a significant association with the use of TDM.ConclusionsMany respondents of the survey have AMS in their ICUs. TDM of antimicrobials and optimized administration of antibiotics are broadly used among respondents. The availability of antimicrobial susceptibility reports and a surveillance of antimicrobial use should be actively sought by intensivists where unavailable. Results of this survey may inform further research and educational activities.
Highlights
Severe infections and multidrug-resistant pathogens are common in critically ill patients
Antimicrobial resistance (AMR) and Antimicrobial stewardship (AMS) were identified as integral components of the intensive care medicine research agenda to be addressed in the future [10]
Due to data protection regulations, the numbers of professionals who were contacted and their email addresses remained unknown to the A-TEAMICU investigators
Summary
Severe infections and multidrug-resistant pathogens are common in critically ill patients. The A-TEAMICU survey was initiated to gain contemporary insights into dissemination and structure of AMS programs and TDM practices in intensive care units. Antimicrobial resistance (AMR) is a concern in many regions of the world [1]. Antimicrobial use and horizontal spread of bacteria have been recognized as the Intensive care units (ICUs) are burdened by large numbers of patients with infections and sepsis, high antimicrobial use, and high rates of resistance [7]. In 2016, experts from the European Society of Intensive Care Medicine (ESICM) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the World Alliance Against Antimicrobial Resistance (WAAAR) held a round table meeting on antimicrobial resistance [9]. AMR and AMS were identified as integral components of the intensive care medicine research agenda to be addressed in the future [10]
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