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Antibiotics
Special Issues
Antimicrobial Stewardship in Critical Care
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Antimicrobial Stewardship in Critical Care

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 11463

Special Issue Editors

Dr. David Cluck

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Guest Editor
Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA
Interests: antimicrobial resistance; antimicrobial stewardship; resistance mechanisms
Dr. Jennifer Tharp

E-Mail Website
Guest Editor
Department of Pharmacy, Johnson City Medical Center, Johnson City, TN 37604, USA
Interests: antimicrobial stewardship; ARDS; sepsis; ICU delirium prevention
Dr. Leslie Hamilton

E-Mail Website
Guest Editor
Health Science Center College of Pharmacy, University of Tennessee, Knoxville, TN 37920, USA
Interests: neurocritical care

Special Issue Information

Dear Colleagues,

The aftermath of the COVID-19 pandemic highlighted the importance antimicrobial stewardship in critically ill patients, as these patients are often most likely to receive broad-spectrum antimicrobial therapy. During the pandemic, stewardship was often not a focal point for hospitalized patients; however, many institutions are now reprioritizing antimicrobial stewardship efforts, including in critically ill patients. This Special Issue aims to capture impactful manuscripts in content areas including but not limited to: 

  1. Examining the intersection of COVID-19 and antimicrobial stewardship;
  2. Lessons learned from the pandemic as it pertains to stewardship;
  3. Novel antimicrobial stewardship approaches in the critically ill patient population;
  4. Stewardship strategies with new antimicrobial therapies;
  5. De-escalation strategies in the ICU.

Dr. David Cluck
Dr. Jennifer Tharp
Dr. Leslie Hamilton
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial stewardship
  • critical care
  • antimicrobial resistance

Published Papers (7 papers)

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Research

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10 pages, 1553 KiB  
Article
Missed Opportunities for Antifungal Stewardship during the COVID-19 Era
by Brandon K. Hawkins, Samantha D. Walker and Mahmoud A. Shorman
Antibiotics 2023, 12(9), 1352; https://doi.org/10.3390/antibiotics12091352 - 23 Aug 2023
Cited by 1 | Viewed by 902
Abstract
Significant increases in antibacterial use were observed during the COVID-19 pandemic. However, subsequent analyses found this increase in antibiotic use to be excessive in comparison with the relatively low rates of bacterial coinfection. Although patients who are critically ill with COVID-19 may be [...] Read more.
Significant increases in antibacterial use were observed during the COVID-19 pandemic. However, subsequent analyses found this increase in antibiotic use to be excessive in comparison with the relatively low rates of bacterial coinfection. Although patients who are critically ill with COVID-19 may be at an increased risk for pulmonary aspergillosis, antifungal use in these populations remained underreported, particularly in later phases of the pandemic. This single-center, population-level cohort analysis compares the monthly use rates of mold-active antifungal drugs in the medical intensive care unit during April 2019–March 2020 (baseline) with those during April 2020–November 2022. The antifungal drugs included in the analysis were liposomal amphotericin B, anidulafungin, isavuconazonium, posaconazole, and voriconazole. We found that during 2020–2022, the usage of antifungal drugs was not significantly different from baseline for all included agents except isavuconazonium, which was used significantly more (p = 0.009). There were no changes in diagnostic modalities between the two time periods. The reported prevalence of and mortality from COVID-19-associated pulmonary aspergillosis (CAPA) may have resulted in higher rates of prescribing antifungal drugs for critically ill patients with COVID-19. Antimicrobial stewardship programs should develop and apply tools to facilitate more effective and appropriate antifungal use. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in Critical Care)
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10 pages, 705 KiB  
Article
Compliance with a Procalcitonin-Based Protocol in Patients with Ventilation-Associated Pneumonia: An Observational, Retrospective Study
by Matthieu Rossi, Louis Delamarre, Gary Duclos, Ines Lakbar, Emmanuelle Hammad, Charlotte Arbelot, Laurent Zieleskiewicz and Marc Leone
Antibiotics 2023, 12(7), 1208; https://doi.org/10.3390/antibiotics12071208 - 20 Jul 2023
Viewed by 895
Abstract
Background: Procalcitonin (PCT) protocols to guide antibiotic treatment for ventilator-associated pneumonia (VAP) in the intensive care unit aim at reducing antibiotic exposure. Our study goal was to measure compliance with a PCT protocol for VAP and to determine the associated variables. Methods: From [...] Read more.
Background: Procalcitonin (PCT) protocols to guide antibiotic treatment for ventilator-associated pneumonia (VAP) in the intensive care unit aim at reducing antibiotic exposure. Our study goal was to measure compliance with a PCT protocol for VAP and to determine the associated variables. Methods: From 2017 to 2021, we conducted a retrospective, monocentric study including patients treated for VAP. In our PCT protocol, PCT was measured at the initiation of antibiotic treatment and every 48 h until treatment completion; antibiotics were stopped if PCT decreased by more than 80% from its highest value or fell below 0.5 ng/mL. We assessed the compliance with the PCT protocol and compared the compliant and noncompliant groups. Results: Among the 177 included patients, compliance with the PCT protocol was assessed at 58%. Noncompliance was due to lack of PCT measurements in 76% of cases. Compliance was higher in the medical patients (p = 0.04) and in those admitted for SARS-CoV-2 (p = 0.02). Compliance regarding the interruption of antibiotic therapy based on PCT was lower on weekends and holidays (p = 0.01). Outcomes did not differ according to compliance. Conclusion: This study assessed real-life compliance with the PCT protocol to monitor antibiotic treatment for VAP. Improving the measurement of PCT at the bedside would increase the rate. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in Critical Care)
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14 pages, 1454 KiB  
Article
Deficiencies of Rule-Based Technology-Generated Antibiograms for Specialized Care Units
by David M. Hill and Lorraine A. Todor
Antibiotics 2023, 12(6), 1002; https://doi.org/10.3390/antibiotics12061002 - 03 Jun 2023
Cited by 1 | Viewed by 1193
Abstract
The objective of this study was to compare the pathogens and susceptibilities of the current automated, rule-based technology (RBT) antibiogram with one manually collected through chart review with additional rules applied. This study was a two-year, retrospective cohort study and included all bacterial [...] Read more.
The objective of this study was to compare the pathogens and susceptibilities of the current automated, rule-based technology (RBT) antibiogram with one manually collected through chart review with additional rules applied. This study was a two-year, retrospective cohort study and included all bacterial cultures within the first 30 days from patients admitted to a single Burn Center. The current RBT antibiogram served as the control, and new antibiogram versions were created using additional rules and compared to the control. Six-hundred fifty-seven patients were admitted (61% excluded for lack of cultures). 59% had at least one hospital-acquired risk factor, with over one-third having recent illicit drug use and one-third having a recent hospitalization. Of the 410 cultures included, 57% were Gram-negative, and half were from wound infections. Sensitivities were significantly different when comparing the manual and the RBT version after including factors such as days since admission, presence of hospital-acquired risk factors, or previous antibiotic courses. Recommended empiric Gram-negative antibiotics changed from double coverage to a single β-lactam with >90% susceptibility. The susceptibilities between the first and subsequent courses were dramatically different. Before developing an antibiogram or interpreting the output, it is important to consider which automated criteria are utilized, especially for units with extended lengths of stay. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in Critical Care)
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12 pages, 556 KiB  
Article
Outcomes of Intravenous Push versus Intermittent Infusion Administration of Cefepime in Critically Ill Patients
by Susan E. Smith, Zachary Halbig, Nicholas R. Fox, Christopher M. Bland and Trisha N. Branan
Antibiotics 2023, 12(6), 996; https://doi.org/10.3390/antibiotics12060996 - 01 Jun 2023
Cited by 2 | Viewed by 2661
Abstract
The equivalence of intravenous push (IVP) and piggyback (IVPB) administration has not been evaluated in the critically ill population for most medications, but it is especially relevant for antibiotics, such as cefepime, that exhibit time-dependent bactericidal activity. A single center, retrospective, observational pre/post-protocol [...] Read more.
The equivalence of intravenous push (IVP) and piggyback (IVPB) administration has not been evaluated in the critically ill population for most medications, but it is especially relevant for antibiotics, such as cefepime, that exhibit time-dependent bactericidal activity. A single center, retrospective, observational pre/post-protocol change study included critically ill adults who received cefepime as empiric therapy between August 2015 and 2021. The primary outcome was treatment failure, which was defined as a composite of escalation of antibiotic regimen or all-cause mortality. Secondary outcomes included adverse drug events, days of cefepime therapy, total days of antibiotic therapy, and ICU and hospital length of stay. Outcomes were compared using Chi-squared, Mann Whitney U, and binary logistic regression as appropriate. A total of 285 patients were included: 87 IVPB and 198 IVP. Treatment failure occurred in 18% (n = 16) of the IVPB group and 27% (n = 54) of the IVP group (p = 0.109). There were no significant differences in secondary outcomes. Longer duration of antibiotics (odds ratio [OR] 1.057, 95% confidence interval [CI] 1.013–1.103), SOFA score (OR 1.269, 95% CI 1.154–1.397) and IVP administration of cefepime (OR 2.370, 95% CI 1.143–4.914) were independently associated with treatment failure. Critically ill patients who received IVP cefepime were more likely to experience treatment failure in an adjusted analysis. The current practice of IVP cefepime should be reevaluated, as it may not provide similar clinical outcomes in the critically ill population. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in Critical Care)
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11 pages, 582 KiB  
Article
Evaluation of an Antifungal Stewardship Initiative Targeting Micafungin at an Academic Medical Center
by J. Myles Keck, David A. Cretella, Kayla R. Stover, Jamie L. Wagner, Katie E. Barber, Tulip A. Jhaveri, Prakhar Vijayvargiya, Zerelda Esquer Garrigos and Mary Joyce B. Wingler
Antibiotics 2023, 12(2), 193; https://doi.org/10.3390/antibiotics12020193 - 17 Jan 2023
Viewed by 1380
Abstract
Delays in the treatment of proven invasive fungal disease have been shown to be harmful. However, empiric treatment for all patients at risk of infection has not demonstrated benefit. This study evaluates the effects of a micafungin stewardship initiative on the duration of [...] Read more.
Delays in the treatment of proven invasive fungal disease have been shown to be harmful. However, empiric treatment for all patients at risk of infection has not demonstrated benefit. This study evaluates the effects of a micafungin stewardship initiative on the duration of therapy and clinical outcomes at the University of Mississippi Medical Center in Jackson, Mississippi. This single-center quasi-experiment evaluated patients who received micafungin. Adult inpatients who received at least one treatment dose of micafungin in the pre-intervention (1 October 2020 to 30 September 2021) or post-intervention (1 October 2021 to 30 April 2022) groups were included. Patients were placed on micafungin for prophylaxis and those who required definitive micafungin therapy were excluded. An algorithm was used to provide real-time recommendations in order to assess change in the treatment days of micafungin therapy. A total of 282 patients were included (141 pre-group versus 141 post-group). Over 80% of the patients included in the study were in an intensive care unit, and other baseline characteristics were similar. The median number of treatment days with micafungin was 4 [IQR 3-6] in the pre-group and 3 [IQR 2-6] in the post-group (p = 0.005). Other endpoints, such as time to discontinuation or de-escalation, hospital mortality, and hospital length of stay, were not significantly different between the groups. An antifungal stewardship initiative can be an effective way to decrease unnecessary empiric antifungal therapy for patients who are at risk of invasive fugal disease. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in Critical Care)
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Review

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21 pages, 366 KiB  
Review
Antimicrobial Stewardship Techniques for Critically Ill Patients with Pneumonia
by Jenna Adams, Kaitlin Ferguson, RaeAnn Hirschy, Erica Konopka, Jordan Meckel, Grace Benanti, Shannon Kuhrau, Fritzie Albarillo, Kevin Chang, Maressa Santarossa, Julia Sapozhnikov, Brian Hoff and Megan A Rech
Antibiotics 2023, 12(2), 295; https://doi.org/10.3390/antibiotics12020295 - 01 Feb 2023
Cited by 2 | Viewed by 2427
Abstract
Pneumonia is common in the intensive care unit (ICU), infecting 27% of all critically ill patients. Given the high prevalence of this disease state in the ICU, optimizing antimicrobial therapy while minimizing toxicities is of utmost importance. Inappropriate antimicrobial use can increase the [...] Read more.
Pneumonia is common in the intensive care unit (ICU), infecting 27% of all critically ill patients. Given the high prevalence of this disease state in the ICU, optimizing antimicrobial therapy while minimizing toxicities is of utmost importance. Inappropriate antimicrobial use can increase the risk of antimicrobial resistance, Clostridiodes difficile infection, allergic reaction, and other complications from antimicrobial use (e.g., QTc prolongation, thrombocytopenia). This review article aims to discuss methods to optimize antimicrobial treatment in patients with pneumonia, including the following: procalcitonin use, utilization of methicillin-resistant Staphylococcus aureus nares testing to determine need for vancomycin therapy, utilization of the Biofire® FilmArray® pneumonia polymerase chain reaction (PCR), and microbiology reporting techniques. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in Critical Care)

Other

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10 pages, 551 KiB  
Brief Report
Optimized Antibiotic Management of Critically Ill Patients with Severe Pneumonia Following Multiplex Polymerase Chain Reaction Testing: A Prospective Clinical Exploratory Trial
by Alexia Verroken, Julien Favresse, Ahalieyah Anantharajah, Hector Rodriguez-Villalobos, Xavier Wittebole and Pierre-François Laterre
Antibiotics 2024, 13(1), 67; https://doi.org/10.3390/antibiotics13010067 - 10 Jan 2024
Viewed by 1112
Abstract
Molecular diagnostic testing is assumed to enable fast respiratory pathogen identification and contribute to improved pneumonia management. We set up a prospective clinical trial at a tertiary hospital intensive care unit including adult patients suspected of severe pneumonia from whom a lower respiratory [...] Read more.
Molecular diagnostic testing is assumed to enable fast respiratory pathogen identification and contribute to improved pneumonia management. We set up a prospective clinical trial at a tertiary hospital intensive care unit including adult patients suspected of severe pneumonia from whom a lower respiratory tract sample could be obtained. During control periods (CPs), routine testing was performed, and during intervention periods (IPs), this testing was completed with the FilmArray Pneumonia Panel plus test (FA-PNEU) executed 24/7. The main objective was to measure the impact of FA-PNEU results in terms of reduced time to targeted antimicrobial treatment administration. Over a 10-month period, analysis was performed on 35 CP and 50 IP patients. The median time to targeted antimicrobial treatment administration was reduced to 4.3 h in IPs compared to 26.4 h in CPs, with 54% of IP patients having FA-PNEU results that led to a treatment modification, of which all but one were targeted. Modifications included 10 (37%) de-escalations, 7 (25.9%) escalations, 3 (11.1%) regimen switches, and 7 (25.9%) complete antimicrobial discontinuations. FA-PNEU results were available with a 42.3 h gain compared to routine identification. This prospective study confirmed retrospective data demonstrating the benefit of FA-PNEU testing in severe pneumonia management of critically ill patients through improved antimicrobial use. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in Critical Care)
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