Discuss strategies to limit antimicrobial resistance (AMR) in the ICU.
Factors driving antimicrobial resistance (AMR) include inappropriate use of antibiotics, inadequate monitoring and surveillance, poor infection control practices and failing antibiotic pipeline.
Strategies to limit AMR include:
1. Antimicrobial Stewardship
Appropriate antimicrobial prescribing (right indication, right drug(s), right dose, right dosing regime, right duration)
Liaison with microbiology / infectious diseases team
Knowledge of local antibiograms
Streamlining to narrow spectrum drugs / oral agents when appropriate Education of staff
Cycling of antibiotics (uncertain benefit)
Antimicrobial prescribing committee
2. Infection control
Isolation / cohorting of patients
Surveillance / screening / monitoring
Appropriate staff:patient ratios
Limit indwelling devices / appropriate asepsis for insertion etc
Care bundles to reduce VAP, reduce time on ventilator, early enteral feeding etc
Adequate source control e.g. surgical drainage of abscesses Future directions include:
More rapid and accurate diagnosis of sepsis
Advances in genomics
Use of bacteriophages
Use of antibiotics in agriculture and animal husbandry
New drug development
Synergistic combinations of antibiotics and drugs with no antimicrobial effect (eg minocycline and loperamide enhances action against staph aureus)
Prevention of resistance development
Prevention of MRO transmission:
Prevention of clinically relevant MRO infections in colonised patients
Management of MRO infections
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