The intensive care medicine research agenda on multidrug-resistant bacteria, antibiotics, and stewardship

Marin H. Kollef*, Matteo Bassetti, Bruno Francois, Jason Burnham, George Dimopoulos, Jose Garnacho-Montero, Jeffrey Lipman, Charles Edouard Luyt, David P. Nicolau, Maarten J. Postma, Antonio Torres, Tobias Welte, Richard G. Wunderink

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

60 Scopus citations

Abstract

Purpose: To concisely describe the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to the management of multidrug-resistant (MDR) bacteria, antibiotic use, and antimicrobial stewardship in the intensive care unit (ICU) setting. Methods: Narrative review based on a systematic analysis of the medical literature, national and international guidelines, and expert opinion. Results: The prevalence of infection of critically ill patients by MDR bacteria is rapidly evolving. Clinical studies aimed at improving understanding of the changing patterns of these infections in ICUs are urgently needed. Ideal antibiotic utilization is another area of uncertainty requiring additional investigations aimed at better understanding of dose optimization, duration of therapy, use of combination treatment, aerosolized antibiotics, and the integration of rapid diagnostics as a guide for treatment. Moreover, there is an imperative need to develop non-antibiotic approaches for the prevention and treatment of MDR infections in the ICU. Finally, clinical research aimed at demonstrating the beneficial impact of antimicrobial stewardship in the ICU setting is essential. Conclusions: These and other fundamental questions need to be addressed over the next decade in order to better understand how to prevent, diagnose, and treat MDR bacterial infections. Clinical studies described in this research agenda provide a template and set priorities for investigations that should be performed in this field.

Original languageEnglish (US)
Pages (from-to)1187-1197
Number of pages11
JournalIntensive Care Medicine
Volume43
Issue number9
DOIs
StatePublished - Sep 1 2017

Keywords

  • Antibiotics
  • Bacteria
  • Multidrug resistance
  • Stewardship

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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