Abstract
Background: The use of antibiotic drugs (ABX) in hospitals, and especially in intensive care units (ICU), is widespread. The early administration of ABX therapy can improve survival rates. The influence and impact of the ABX are observed in the patients who receive them (clinical response, course) and in the ecosystem surrounding the patient (hospital flora). Aim of the review: The objective of this review is to identify strategies that reduce or limit the appearance and transmission of multidrug-resistant microorganisms. This identification can then develop a rational use of the ABX plan in the ICU. Method: The following databases were queried; Medline, Embase, The Cochrane Library, and the Centre for Reviews and Dissemination (University of York), asking the questions in PICO format to evaluate the efficacy and safety of several interventions: A) Therapeutic de-escalation; B) Cycling of ABX and; C) Early antibiotic treatment. Results: A) In therapeutic de-escalation of 98 studies identified, three studies that met the inclusion criteria were analyzed. B) Two studies comparing antibiotic cycling versus other interventions were selected. C) No studies have been found with sufficiently robust methodological designs that address the ABX early treatment. There is no strong evidence to indicate which of the different antibiotic interventions (therapeutic de-escalation, cycling of ABX and preemptive treatment) is more effective in reducing antibiotic resistance in ICU patients. There is insufficient evidence that de-escalation of antimicrobial agents is effective against resistance. In patients admitted to the ICU with a low prevalence of fluoroquinolones resistance, increased exposure to this class of antibiotics, using antibiotic cycling, increases the emergence of resistant strains. Conclusion: Despite the fact that no prospective studies were identified in this SR, rationale and day-to-day clinical practice experience suggest that multidisciplinary participation of different specialists in ABX's Infection and Policy Commission (or the ABX Commission), or the Pharmacy and Therapeutics Committee, might improve the development and application of these strategies.
Highlights
The use of antibiotic drugs (ABX) in hospitals, and especially in intensive care units (ICU), is widespread
There is no strong evidence to indicate which of the different antibiotic interventions is more effective in reducing antibiotic resistance in ICU patients
In patients admitted to the ICU with a low prevalence of fluoroquinolones resistance, increased exposure to this class of antibiotics, using antibiotic cycling, increases the emergence of resistant strains
Summary
The use of antibiotic drugs (ABX) in hospitals, and especially in intensive care units (ICU), is widespread. The influence and impact of the ABX are observed in the patients who receive them (clinical response, course) and in the ecosystem surrounding the patient (hospital flora) This impact is especially visible in the critically ill patients in the endemic flora of the ICU (Alvarez Lerma et al, 2010). Treatment with broad-spectrum ABX is generally used for early treatment, since it has been shown that preemptive treatment, with the appropriate ABX, reduced mortality rates This approach may expose individuals to excessive use of ABX and the selection of resistance to these pathogens (Silva et al, 2013).The European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA) estimated that each year 25,000 Europeans die as a direct consequence of a multidrugresistant infection (ECDC/EMA, 2009).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: International Journal of Perceptions in Public Health
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
