Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Sep;43(9):1187-1197.
doi: 10.1007/s00134-017-4682-7. Epub 2017 Feb 4.

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

Marin H Kollef  1 , Matteo Bassetti  2 , Bruno Francois  3 , Jason Burnham  4 , George Dimopoulos  5 , Jose Garnacho-Montero  6   7 , Jeffrey Lipman  8   9 , Charles-Edouard Luyt  10   11 , David P Nicolau  12 , Maarten J Postma  13 , Antonio Torres  14 , Tobias Welte  15 , Richard G Wunderink  16
Affiliations
Review

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

Marin H Kollef et al. Intensive Care Med. 2017 Sep.

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.

Keywords: Antibiotics; Bacteria; Multidrug resistance; Stewardship.

PubMed Disclaimer

Conflict of interest statement

Compliance with ethical standards

Conflicts of interest

Dr. Kollef is an investigator for the Arsanis and Aridis monoclonal antibody studies. Dr. Francois is an investigator for the Aridis monoclonal antibody study.

Figures

Fig. 1
Fig. 1
Schematic representing the essential factors needing to be considered in order to optimize antibiotic treatment and outcomes in critically ill patients. PK pharmacokinetic; PD pharmacodynamics; MIC minimum inhibitory concentration
See this image and copyright information in PMC

References

    1. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, Lynfield R, Maloney M, McAllister-Hollod L, Nadle J, Ray SM, Thompson DL, Wilson LE, Fridkin SK, Infections Emerging Infections Program Healthcare-Associated, Team Antimicrobial Use Prevalence Survey (2014) Multistate point-prevalence survey of health care-associated infections. N Engl J Med 370(13):1198–1208. doi:10.1056/NEJMoa1306801 - DOI - PMC - PubMed
    1. Albiger B, Glasner C, Struelens MJ, Grundmann H, Monnet DL, EuropeanSurveyof Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) working group (2015) Carbapenemase-producing Enterobacteriaceae in Europe: assessment by national experts from 38 countries, May 2015. Euro Surveill. doi:10.2807/1560-7917.ES.2015.20.45.30062 - DOI - PubMed
    1. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL (2012) Multidrug-resistant, extensively drug-resistant and pandrugresistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18(3):268–281. doi:10.1111/j.1469-0691.2011.03570.x - DOI - PubMed
    1. Kollef MH, Sherman G, Ward S, Fraser VJ (1999) Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 115:462–474 - PubMed
    1. Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jimenez-Jimenez FJ, Perez-Paredes C, Ortiz-Leyba C (2003) Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 31:2742–2751. doi:10.1097/01.CCM.0000098031.24329.10 - DOI - PubMed

MeSH terms

Substances