The Influence of Antimicrobial Stewardship Measures on Outcome of Patients with Severe Infections treated in Intensive Care Unit

master's thesis

• Title (croatian): Utjecaj mjera upravljanja antibioticima na ishod bolesnika s teškim infekcijama liječenih u jedinici intenzivnog liječenja
• Author: Amela Zjajo
• Mentor: Vladimir Krajinović (mentor)
• Committee member: Vladimir Krajinović (predsjednik povjerenstva)
• Committee member: Marko Kutleša (član povjerenstva)
• Committee member: Ana Budimir (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Infectious Diseases); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Infectology

Abstract

Antibiotic resistance poses a public health challenge worldwide. The intensive care units (ICUs) are characterized by the highest prevalence of multidrug-resistant microorganisms (MDRs) compared to other units in the hospital. The main reasons can be attributed to multiple factors: the higher average age of patients admitted, the larger number of concomitant diseases, and the more pronounced immunosuppression. In addition, many invasive technologies are used in these departments, which creates an additional risk of infections with MDR microorganisms.
Stewardship was initially introduced into healthcare through antimicrobial stewardship (AMS), as a means of responsibly managing healthcare resources. AMS, an important aspect of healthcare, focuses on optimizing antimicrobial use to combat antimicrobial resistance (AMR). This includes educating prescribers, revising and implementing programs, monitoring antimicrobial use and resistance patterns. Key elements of AMS programs include assessing patient conditions, controlling infection sources, selecting appropriate antimicrobials, following treatment guidelines, and reassessing therapy based on culture results. Inappropriate use of antibiotics such as prolonged empiric treatment or failure to tailor therapy accordingly contributes to increased resistance.
The future of AMS involves addressing the global threat of multidrug-resistant pathogens by implementing interdisciplinary strategies, educating healthcare workers, and integrating advanced technologies such as artificial intelligence (AI) and rapid diagnostics. Recognizing the connection of animal and environmental health, in the fight against resistance is a key aspect of adopting a One Health approach. Multiple strategies are employed to achieve this goal, including the establishment of dedicated AMS teams, restrictions on the use of broad-spectrum antimicrobials, early termination of treatments, implementation of early warning systems, emphasis on infection control measures and provision of education and feedback to healthcare providers. This review explores the current practices and strategies employed in AMS within ICUs as well as the influence of the AMSs on patient outcomes, underscoring the significance of responsible antibiotic usage to improve patient outcomes and combat AMR effectively.

Abstract (croatian)

Otpornost na antibiotike predstavlja izazov za javno zdravlje u cijelom svijetu. Jedinice intenzivnog liječenja (JIL) karakterizira najveća prevalencija multirezistentnih mikroorganizama (MDR) u usporedbi s drugim jedinicama u bolnici. Glavni razlozi mogu se pripisati višestrukim čimbenicima: višoj prosječnoj dobi primljenih pacijenata, većem broju popratnih bolesti i izraženijoj imunosupresiji. Osim toga, na tim se odjelima koriste mnoge invazivne tehnologije, što stvara dodatni rizik od infekcija MDR mikroorganizmima.
Pojam Stewardship (Upravljanje), je prvotno uveden u zdravstvo kroz antimikrobno upravljanje (AMS), kao način odgovornog upravljanja resursima zdravstvene skrbi. AMS, važan aspekt zdravstvene skrbi, usredotočen je na optimizaciju uporabe antimikrobnih sredstava za borbu protiv antimikrobne rezistencije (AMR). To uključuje edukaciju liječnika koji propisuju lijekove, reviziju i provedbu programa, praćenje upotrebe antimikrobnih lijekova i obrazaca rezistencije. Ključni elementi AMS programa uključuju procjenu stanja bolesnika, kontrolu izvora infekcije, odabir odgovarajućih antimikrobnih lijekova, praćenje smjernica za liječenje i ponovnu procjenu terapije na temelju rezultata kulture. Neodgovarajuća uporaba antibiotika, kao što je produljeno empirijsko liječenje ili neuspjeh u prilagođavanju terapije u skladu s tim, pridonosi povećanju otpornosti.
Budućnost AMS-a uključuje rješavanje globalne prijetnje patogena rezistentnih na više lijekova provedbom interdisciplinarnih strategija, edukacijom zdravstvenih radnika i integracijom naprednih tehnologija kao što su umjetna inteligencija (AI) i brza dijagnostika. Prepoznavanje povezanosti zdravlja životinja i okoliša u borbi protiv otpornosti ključni je aspekt usvajanja pristupa „Jedno zdravlje“. Za postizanje ovog cilja koristi se više strategija, uključujući uspostavu namjenskih AMS timova, ograničenja upotrebe antimikrobnih lijekova širokog spektra, rani prekid liječenja, provedbu sustava ranog upozoravanja, naglasak na mjerama kontrole infekcija i pružanje obrazovanja i povratnih informacija osobama pružateljima zdravstvenih usluga. Ovaj pregled istražuje trenutne prakse i strategije koje se koriste u AMS-u unutar JIL-a kao i utjecaj AMS-a na ishode pacijenata, naglašavajući važnost odgovorne upotrebe antibiotika za poboljšanje ishoda pacijenata i učinkovitu borbu protiv AMR-a u JIL-a.

• Keywords: Antimicrobial stewardship; multidrug-resistant; intensive care units; rational antibiotic usage; severe infections; infection control; antibiotics; healthcare-associated infections; surveillance
• Keywords (croatian): antimikrobno upravljanje; multirezistentnost; jedinice intenzivnog liječenja; racionalna uporaba antibiotika; teške infekcije; kontrola infekcija; antibiotici; infekcije povezane sa zdravstvenom skrbi; nadzor
• Language: english
• URN:NBN: urn:nbn:hr:105:735179
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-10-21 09:22:54