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      Antibiotic stewardship in the intensive care unit

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      , , ,
      Critical Care
      BioMed Central

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          Abstract

          The rapid emergence and dissemination of antimicrobial-resistant microorganisms in ICUs worldwide constitute a problem of crisis dimensions. The root causes of this problem are multifactorial, but the core issues are clear. The emergence of antibiotic resistance is highly correlated with selective pressure resulting from inappropriate use of these drugs. Appropriate antibiotic stewardship in ICUs includes not only rapid identification and optimal treatment of bacterial infections in these critically ill patients, based on pharmacokinetic-pharmacodynamic characteristics, but also improving our ability to avoid administering unnecessary broad-spectrum antibiotics, shortening the duration of their administration, and reducing the numbers of patients receiving undue antibiotic therapy. Either we will be able to implement such a policy or we and our patients will face an uncontrollable surge of very difficult-to-treat pathogens.

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          Most cited references167

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          Antibiotic resistance-the need for global solutions.

          The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Similarities with climate change are evident. Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections. Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken. Here, we describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.

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              Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock*

              Critical Care Medicine, 34(6), 1589-1596
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                Author and article information

                Contributors
                charles-edouard.luyt@psl.aphp.fr
                nicolas.brechot@psl.aphp.fr
                jean-louis.trouillet@psl.aphp.fr
                jean.chastre@psl.aphp.fr
                Journal
                Crit Care
                Critical Care
                BioMed Central (London )
                1364-8535
                1466-609X
                13 August 2014
                2014
                : 18
                : 5
                : 480
                Affiliations
                Medical-Surgical Intensive Care Unit, ICAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l’Hôpital, 75651 Paris, Cedex 13 France
                Article
                480
                10.1186/s13054-014-0480-6
                4281952
                25405992
                601f350f-f5a6-4629-b1ff-809c5af2a70e
                © Luyt et al.; licensee BioMed Central Ltd. 2014

                The licensee has exclusive rights to distribute this article, in any medium, for 12 months following its publication. After this time, the article is available under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0) applies to the data made available in this article, unless otherwise stated.

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                Review
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                © The Author(s) 2014

                Emergency medicine & Trauma
                Emergency medicine & Trauma

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