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Principles and Practice of Antibiotic Stewardship in the ICU

Chiagozie I Pickens, Richard G Wunderink, Chiagozie I Pickens
Chest 2019 January 25
In the face of emerging drug resistant pathogens and a decrease in the development of new antimicrobial agents, antibiotic stewardship should be practiced in all critical care units. Antibiotic stewardship should be a core competency of all critical care practitioners in conjunction with a formal Antibiotic Stewardship Program (ASP). Prospective audit and feedback, and antibiotic time outs are effective components of an ASP in the ICU. As rapid diagnostics are introduced in the ICU, assessment of performance and effect on outcomes will clearly be needed. Disease-specific stewardship for community-acquired pneumonia relying on clinical pathways may be particularly high yield. Computerized decision support has the potential to individualize stewardship for specific patients. Finally, infection control and prevention is the cornerstone of every ASP.


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