Impact of Antimicrobial Stewardship Programs on Patient Care in the ICU

The prompt administration of antibiotic treatment can mean the difference between life or death, especially in extreme cases. Sepsis, for example, is a life-threatening illness that is common in the ICU. When dealing with sepsis, it is critical to administer empiric antibiotic therapy to the patient as soon as possible to decrease the likelihood of morbidity. Infections that are urgent and serious threats for ICUs’ patients are frequently caused by pathogens such as Enterobacterales producing extended-spectrum beta-lactamase (ESBLs), carbapenem-resistant Enterobacterales (CRE), MDR-Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA).

Antibiotic overuse is common in healthcare settings around the world. In ICUs alone, data indicates that  up to 70% of patients are prescribed at least one course of antibiotics during treatment. Antibiotic consumption is estimated to be 10 times higher in ICUs when compared to other care environments. In addition to the treatment of infections, the substantial increase in antibiotic utilization in these settings can be attributed to antibiotics also prescribed as perioperative prophylaxis to prevent or limit major infections in patients who are critically ill.  

Clinicians and intensive care support teams must ensure that antibiotic use is appropriate and optimized to outweigh the negative side effects antibiotics may bring to the patient, as well as contribution to the AMR pandemic. While antibiotic treatment may be necessary in many cases, the unnecessary or suboptimal use of antibiotics can come with serious implications, such as an increase in mortality, a longer length of hospital stay, and an increase in healthcare costs. 

Without widespread intervention, antibiotic resistant pathogens will continue to emerge, making it more difficult to treat infections. Intensive care and infectious disease specialists from organizations such as the European Society of Intensive Care Medicine, and the World Alliance Against Antimicrobial Resistance, have called for increased awareness and action to reduce AMR development in high-risk patient populations such as those in intensive care.

Initiatives such as antimicrobial stewardship (AMS) are encouraged in many healthcare settings to support the optimized use of antimicrobials. Stewardship programs often prioritize the five Ds of stewardship: right diagnosis, right drug, right dose, right duration, and de-escalation. A recent antimicrobial stewardship study conducted in an ICU setting suggests that the implementation of AMS programs not only assists the fight against AMR, but they also support clinicians in providing better patient care. The study, which included 150 patients diagnosed with sepsis/septic shock or Ventilator Associated Pneumonia (VAP), demonstrated the importance of AMS programs and their ability to reduce the unnecessary use of broad-spectrum antibiotics, slow the development of resistant pathogens.

Diagnostic tests play a pivotal role in the success of AMS programs. Findings from this study conclude that stewardship by means of ordering diagnostic tests and procedures to confirm an accurate diagnosis significantly increased patient quality-care scores.

With an accurate diagnosis, healthcare teams can initiate the appropriate treatment for the patient sooner, avoiding antibiotic misuse and overuse. “Immediate diagnostics are essential for a successful treatment of life threatening conditions, early recognition of complications and good quality of care,” state the authors of this journal article. Diagnostic tests can also help to provide clinicians with the data needed to determine when it’s appropriate to safely de-escalate or discontinue antibiotic treatment. Some of the most common diagnostic tests in the ICU setting include bedside ultrasonography, radiologic diagnostics, and point-of-care (POC) tests.  

Antimicrobial stewardship programs (ASPs) have been shown to be beneficial in many facets of patient care including reductions in antibiotic costs. If necessary, an ASP can be implemented without an ID specialist in limited resource settings; however, the authors note of the study, “The implementation of ASPs (Antimicrobial Stewardship Programs) in centers where antimicrobial management of ICU patients is largely controlled by infectious diseases specialists, remains a feasible strategy that leads to better patient care.”

Optimizing the use of antibiotics through AMS is an essential part of combatting AMR and protecting patient health and safety. In critically ill populations such as those under close supervision in the ICU, it is especially important to ensure the right course of antimicrobial therapy at the right time. Such actions not only help prevent the spread and emergence of resistant pathogens, but also can possibly improve the standard of care for patients and potentially support better clinical outcomes.