Adult Intensive Care Unit antimicrobial Stewardship program: An integrative review
DOI:
https://doi.org/10.33448/rsd-v13i6.45883Keywords:
Intensive care unit; Bacterial resistance; Infection control; Antimicrobial stewardship.Abstract
ICU patients are more likely to acquire health-related infections due to their severe clinical condition and the inappropriate use of antimicrobials, which can lead to increased bacterial resistance. In this context, a strategy for the control of bacterial resistance is Antimicrobial Stewardship defined as coordinated interventions to reduce the inappropriate use of antimicrobials, reduce the development of resistance and reduce costs. Objective: To conduct an integrative review on the application of antimicrobial stewardship to clinical and economic outcomes of adult ICU patients. Methodology: This review adopted the PICo strategy to ask the question "What improvements can the antimicrobial stewardship program bring to adult intensive care units?" The following databases were used: LILACS, PubMed Central, SCOPUS, EMBASE, WEB OF SCIENCE, SCIENCE DIRECT and MEDLINE, with articles published in English between 2018 and 2023. The DeCS and MeSH descriptors were: "Intensive Care Units", "Antimicrobial Stewardship", "Drug Resistance, Bacterial", "Infection Control”. Results: Twelve studies were in agreement with the established inclusion criteria and demonstrated that adherence to the interventions proposed by the Antimicrobial Stewardship Program is associated with a decrease in the time and doses of antibiotic therapy, in addition to stimulating rational use in the ICU. Conclusion: The Stewardship Program for Antimicrobials in adult ICUs brings benefits in reducing bacterial resistance and the use of antimicrobials. Consequently, reducing hospital costs, with the pharmacist being the key player in the strategy for the rational and safe use of antimicrobials.
References
Adhikari, S., Piza, M., Taylor, P., Deshpande, K., Lam, D., & Konecny, P. (2018). Sustained multimodal antimicrobial stewardship in an Australian tertiary intensive care unit from 2008-2015: an interrupted time-series analysis. International journal of antimicrobial agents, 51(4), 620–628.
https://doi.org/10.1016/j.ijantimicag.2018.01.017
Álvarez-Lerma, F., Grau, S., Echeverría-Esnal, D., Martínez-Alonso, M., Gracia-Arnillas, M. P., Horcajada, J. P., & Masclans, J. R. (2018). A Before-and-After Study of the Effectiveness of an Antimicrobial Stewardship Program in Critical Care. Antimicrobial agents and chemotherapy, 62(4), e01825-17. https://doi.org/10.1128/AAC.01825-17
American Society of Health-System Pharmacists (ASHP) (2010). Statement on the Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and Control, American Journal of Health-System Pharmacy, 67, (7), 575–577. https://doi.org/10.2146/sp100001
Anvisa. Agência Nacional de Vigilância Sanitária (2019) Projeto Stewardship Brasil. Avaliação Nacional dos Programas de Gerenciamento do Uso de Antimicrobianos em Unidade de Terapia Intensiva Adulto dos Hospitais Brasileiros. https://antigo.anvisa.gov.br/documents/33852/271855/Projeto+Stewardship+Brasil/435012dc-4709-4796-ba78-a0235895d901?version=1.0
Anvisa Agência Nacional de Vigilância Sanitária (2023). Principais Etapas para Elaboração e Implementação de um Programa de Gerenciamento de Antimicrobianos. https://www.gov.br/anvisa/pt-br/assuntos/servicosdesaude/prevencao-e-controle-de-infeccao-e-resistencia-microbiana/FasesPGAANVISA12062023.pdf
Barros, A., Monroy, H., Bergo, P., Beck, E., David, L., & Rigatto, M. H. (2022). Antimicrobial stewardship programme associated with earlier prescription of in vitro susceptible therapy and lower 14-day mortality in patients with carbapenem-resistant Enterobacterales bacteraemia: a cohort study. Journal of global antimicrobial resistance, 28, 130–135. https://doi.org/10.1016/j.jgar.2021.12.011
Blot, S., Ruppé, E., Harbarth, S., Asehnoune, K., Poulakou, G., Luyt, C. E., Rello, J., Klompas, M., Depuydt, P., Eckmann, C., Martin-Loeches, I., Povoa, P., Bouadma, L., Timsit, J. F., & Zahar, J. R. (2022). Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive & critical care nursing, 70, 103227. https://doi.org/10.1016/j.iccn.2022.103227
Brasil. Resolução n° 7, de 24 de Fevereiro de 2010. Dispõe sobre os requisitos mínimos para funcionamento de Unidades de Terapia Intensiva e dá outras providências. https://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2010/res0007_24_02_2010.html
Centros de Controle e Prevenção de Doenças (CDC). (2019)Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC; Available at https://www.cdc.gov/antibiotic-use/core-elements/hospital.html
Chamieh, A., Nawfal, T. D., Ballouz, T., Afif, C., Juvelekian, G., Hlais, S., Rolain, J. M., & Azar, E. (2019). Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit. Emerging infectious diseases, 25(10), 1928–1931. https://doi.org/10.3201/eid2510.181626
Chen, I. L., Lee, C. H., Su, L. H., Wang, Y. L., & Liu, J. W. (2018). Effects of implementation of an online comprehensive antimicrobial-stewardship program in ICUs: A longitudinal study. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi, 51(1), 55–63. https://doi.org/10.1016/j.jmii.2016.06.007
Conselho Federal de Farmácia (CFF) (2019). Resolução n°675, de 31 de outubro de 2019. Regulamenta as atribuições do farmacêutico clínico em unidades de terapia intensiva, e dá outras providências. https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=21/11/2019&jornal=515&pagina=128&totalArquivos=133
Dellit, T. H., Owens, R. C., McGowan, J. E., Jr, Gerding, D. N., Weinstein, R. A., Burke, J. P., Huskins, W. C., Paterson, D. L., Fishman, N. O., Carpenter, C. F., Brennan, P. J., Billeter, M., Hooton, T. M., Infectious Diseases Society of America, & Society for Healthcare Epidemiology of America (2007). Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 44(2), 159–177. https://doi.org/10.1086/510393
El-Sokkary, R. H., Negm, E. M., Othman, H. A., Tawfeek, M. M., & Metwally, W. S. (2020). Stewardship actions for device associated infections: An intervention study in the emergency intensive care unit. Journal of infection and public health, 13(12), 1927–1931. https://doi.org/10.1016/j.jiph.2020.10.003
Gu, H., Sun, L., Sheng, B., Gu, X., Wang, S., Liu, L., Dai, B., & Chen, W. (2023). Benefits of pharmacist intervention in the critical care patients with infectious diseases: A propensity score matching retrospective cohort study. Australian critical care : official journal of the Confederation of Australian Critical Care Nurses, 36(6), 933–939. https://doi.org/10.1016/j.aucc.2022.12.011
Khdour, M. R., Hallak, H. O., Aldeyab, M. A., Nasif, M. A., Khalili, A. M., Dallashi, A. A., Khofash, M. B., & Scott, M. G. (2018). Impact of antimicrobial stewardship programme on hospitalized patients at the intensive care unit: a prospective audit and feedback study. British journal of clinical pharmacology, 84(4), 708–715. https://doi.org/10.1111/bcp.13486
Kim, S. H., Yoon, J. G., Park, H. J., Won, H., Ryoo, S. S., Choi, E., Park, E. K., Huh, K., & Park, C. M. (2021). Effects of a comprehensive antimicrobial stewardship program in a surgical intensive care unit. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 108, 237–243. https://doi.org/10.1016/j.ijid.2021.02.082
Jim O’Neill, (2016). The review on antimicrobial resistance chaired tackling drug-resistant infections globally: Final report and recommendations. https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine, 6(7), e1000100. https://doi.org/10.1371/journal.pmed.1000100
Maragakis, L. L., Perencevich, E. N., & Cosgrove, S. E. (2008). Clinical and economic burden of antimicrobial resistance. Expert review of anti-infective therapy, 6(5), 751–763. https://doi.org/10.1586/14787210.6.5.751
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: step by step: the seven steps of evidence-based practice. The American journal of nursing, 110(1), 51–53. https://doi.org/10.1097/01.NAJ.0000366056.06605.d2
Mendes, K. D. S., Silveira, R. C. De C.P., Galvão, C.M. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto – Enfermagem, 17(4):758–64. http://doi.org/10.1590/S0104-07072008000400018
Menezes, RM, Gonçalves, MRS., Costa, MM de M., Krumennauer, EC., Carneiro, GM., Reuter, CP, Renner, JDP., & Carneiro, M. (2022). Programas de manejo antimicrobiano no Brasil: análise introdutória. Pesquisa, Sociedade e Desenvolvimento , 11 (7), e51011729444. https://doi.org/10.33448/rsd-v11i7.29444
Nathwani, D., Varghese, D., Stephens, J., Ansari, W., Martin, S., & Charbonneau, C. (2019). Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review. Antimicrobial resistance and infection control, 8, 35. https://doi.org/10.1186/s13756-019-0471-0
Naylor, N. R., Atun, R., Zhu, N., Kulasabanathan, K., Silva, S., Chatterjee, A., Knight, G. M., & Robotham, J. V. (2018). Estimating the burden of antimicrobial resistance: a systematic literature review. Antimicrobial resistance and infection control, 7, 58. https://doi.org/10.1186/s13756-018-0336-y
Onorato, L., Macera, M., Calò, F., Monari, C., Russo, F., Iovene, M. R., Signoriello, G., Annibale, R., Pace, M. C., Aurilio, C., Gaeta, G. B., & Coppola, N. (2020). The effect of an antimicrobial stewardship programme in two intensive care units of a teaching hospital: an interrupted time series analysis. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 26(6), 782.e1–782.e6. https://doi.org/10.1016/j.cmi.2019.10.021
Panditrao, A., Shafiq, N., Kumar-M, P., Sekhon, A. K., Biswal, M., Singh, G., Kaur, K., Ray, P., Malhotra, S., Gautam, V., Gupta, R., Gupta, V., Yadav, T. D., Laroiya, I., Kumar, H., & Salvania, A. (2021). Impact of an antimicrobial stewardship and monitoring of infection control bundle in a surgical intensive care unit of a tertiary-care hospital in India. Journal of global antimicrobial resistance, 24, 260–265. https://doi.org/10.1016/j.jgar.2021.01.003
Rizk, N. A., Zahreddine, N., Haddad, N., Ahmadieh, R., Hannun, A., Bou Harb, S., Haddad, S. F., Zeenny, R. M., & Kanj, S. S. (2022). The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon. Antibiotics (Basel, Switzerland), 11(7), 911. https://doi.org/10.3390/antibiotics11070911
Rupali, P., Palanikumar, P., Shanthamurthy, D., Peter, J. V., Kandasamy, S., Zacchaeus, N. G. P., Alexander, H., Thangavelu, P., Karthik, R., Abraham, O. C., Michael, J. S., Paul, H., Veeraraghavan, B., Chacko, B., Jeyaseelan, V., Alangaden, G., Prentiss, T., & Zervos, M. J. (2019). Impact of an antimicrobial stewardship intervention in India: Evaluation of post-prescription review and feedback as a method of promoting optimal antimicrobial use in the intensive care units of a tertiary-care hospital. Infection control and hospital epidemiology, 40(5), 512–519. https://doi.org/10.1017/ice.2019.29
Schmid, S., Schlosser, S., Gülow, K., Pavel, V., Müller, M., & Kratzer, A. (2022). Interprofessional Collaboration between ICU Physicians, Staff Nurses, and Hospital Pharmacists Optimizes Antimicrobial Treatment and Improves Quality of Care and Economic Outcome. Antibiotics (Basel, Switzerland), 11(3), 381. https://doi.org/10.3390/antibiotics11030381
Stern, C., Jordan, Z., & McArthur, A. (2014). Developing the review question and inclusion criteria. The American journal of nursing, 114(4), 53–56. https://doi.org/10.1097/01.NAJ.0000445689.67800.86
Weier, N., Tebano, G., Thilly, N., Demoré, B., Pulcini, C., & Zaidi, S. T. R. (2018). Pharmacist participation in antimicrobial stewardship in Australian and French hospitals: a cross-sectional nationwide survey. The Journal of antimicrobial chemotherapy, 73(3), 804–813. https://doi.org/10.1093/jac/dkx435
WHO.(2019) Ten threats to global health in 2019.https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
WHO. (2023). Antimicrobial Resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
World Bank Group. (2017) Drug-resistant infections: a threat to our economic future. Washington DC. http://documents.worldbank.org/curated/en/323311493396993758/pdf/114679-REVISED-v2-Drug-Resistant-Infections-Final-Report.pdf
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