Antibiotic Use in the Intensive

Care Unit: Optimization and De-

Escalation
Introduction
• Effective antimicrobial therapy is critical for the treatment of patients in the intensive care unit
(ICU), including patients admitted with severe sepsis, septic shock, and those who develop
health-care-associated infections
• Delays in appropriate antimi- crobial therapy worsen outcomes in critically ill patients
• Multidrug-resistant organisms are increasingly common and are associated with a longer length
of stay, ICU admission, and higher mortality rates
• Initiating effective therapy for infections based upon patients’ risk factors, collection of
appropriate cultures, daily evaluation of clinical status, and laboratory data, including antibiotic
time outs, and shortened durations of therapy are ways to improve patient out- comes
• Special attention should be paid to the dosing of antimicrobials in the ICU, as fluctuations in fluid
status, organ function, and perfusion can affect antibiotic pharmacokinetics and therefore
antibiotic efficacy at the site of infection
• This analitic reviews the most recent evidence supporting empiric antibiotic selection, de-
escalation strategies, the importance of optimized antimicrobial doses, and antimicro- bial
stewardships role in the ICU
 •Select antibiotics based upon national guidelines and local
susceptibilities
•Patient specific factors (immunosuppression, indwelling catheters,
Optimization
Initiate allergies)
•Common pathogens for suspected source

•Daily review of clinical signs and symptoms of infection

Utilize
•Review of cultures and molecular diagnostics
pharmacokinetic/
Evaluate •Analyze current dosing strategy
pharmacodynamic
principles to increase
cidality

•Narrow therapy based upon cultures and to

minimize adverse events
Antimicrobial De-escalate •Consider shorter durations based upon
clinical status
Stewardship