Antimicrobial Stewardship in the ICU

Treating patients with multidrugresistant (MDR) pathogens is an increasing challenge for intensive care unit (ICU) physicians. In the ICU, compared to other hospital departments, severe infections are most prevalent and antimicrobial use is most abundant. Not surprisingly, antimicrobial resistance (AMR) has emerged primarily in the intensive care setting, where multiple facilitators for the development of resistance are present: high antibiotic pressure, loss of physiological barriers, and high transmission risk. There have been numerous reports on outbreaks with MDR pathogens in ICUs (French et al. 2017). In some parts of the world ICU physicians are struggling with the outlook of a “post-antibiotic era”, where there are no antibiotics available to treat common ICU infections (MacVane 2017). With no new drugs in the pipeline for MDR pathogens, implementation of an antimicrobial stewardship programme (ASP) seems a reasonable pathway to help prevent the further development of resistance (Bassetti et al. 2016).