Feasibility of Antimicrobial Stewardship (AMS) in critical care settings: a multidisciplinary approach strategy

Submitted by Repositório Arca ([email protected]) on 2019-04-24T17:53:34Z No. of bitstreams: 1 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-07-16T15:11:53Z (GMT) No. of bitstreams: 2 ve_Tiszai-Szucs_Tamas_etal_INI_2018.pdf: 214041 bytes, checksum: d881ea813e0561540f5e3993e8f00a5e (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2019-07-16T15:11:53Z (GMT). No. of bitstreams: 2 ve_Tiszai-Szucs_Tamas_etal_INI_2018.pdf: 214041 bytes, checksum: d881ea813e0561540f5e3993e8f00a5e (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2018St James’s Hospital. Department of Anaesthesia and Critical Care Medicine. Dublin, Ireland.St James’s Hospital. Department of Anaesthesia and Critical Care Medicine. Dublin, Ireland.St James’s Hospital. Department of Anaesthesia and Critical Care Medicine. Dublin, Ireland.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.St James’s Hospital. Department of Anaesthesia and Critical Care Medicine. Dublin, Ireland.St James’s Hospital. Department of Anaesthesia and Critical Care Medicine. Dublin, Ireland / St James’s Hospital. Multidisciplinary Intensive Care Research Organization. Dublin, Ireland / Trinity Centre for Health Sciences. Dublin, Ireland / CIBER Enfermedades Respiratorias. Madrid, Spain.Antimicrobial resistance is escalating and triggers clinical decision-making challenges when treating infections in patients admitted to intensive care units (ICU). Antimicrobial stewardship (AMS) may help combat this problem, but it can be difficult to implement in critical care settings. The implementation of multidisciplinary AMS in ICUs could be more challenging than what is currently suggested in the literature. Our main goal was to analyze the reduction in duration of treatment (DOT) for the most commonly used antibacterial and antifungal agents during the first six months of 2014, and during the same period two years later (2016). A total of 426 and 424 patient encounters, respectively, were documented and collected from the intensive care unit’s electronic patient record system. Daily multidisciplinary ward rounds were conducted for approximately 30–40 min, with the goal of optimizing antimicrobial therapy in order to analyze the feasibility of implementing AMS. The only antimicrobial agent which showed a significant reduction in the number of prescriptions and in the duration of treatment during the second audit was vancomycin, while linezolid showed an increase in the number of prescriptions with no significant prolongation of the duration of treatment. A trend of reduction was also seen in the DOT for co-amoxiclavulanate and in the number of prescriptions of anidulafungin without any corresponding increases being observed for other broad-spectrum anti-infective agents (p-values of 0.07 and 0.05, respectively)