A Practical Approach to Clinical Antibiotic Stewardship in the ICU Patient With Severe Infection

Jan Fierens, MD; Pieter O. Depuydt, MD, PhD; Jan J. De Waele, MD, PhD


Semin Respir Crit Care Med. 2019;40(4):435-446. 

In This Article

Concluding Remarks

ASPs have been around for more than 2 decades and have gained widespread acceptance within the ICU community. However, it needs to keep evolving to keep up with the rising incidence of infections caused by MDR pathogens. While ASPs seem highly relevant for the most severe infections, data in this patient group are limited. This warrants well-designed studies addressing three priorities: the role for the new techniques in the field of rapid diagnostics, the benefit of combination therapy versus single antibiotic therapy in severe infections, and the optimal duration of treatment in these most critically ill patients. Currently, we suggest a pragmatic three-step approach during antibiotic treatment to improve antibiotic selection, to adjust treatment and to limit duration of an antibiotic course, combined with the importance of adequate source control. In a more and more complex ICU environment, a team approach and the use of CDSS are two possible adjuncts helping the clinician optimize the ASP in the patient with severe infection.