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Intensive Care Medicine
Published in: Intensive Care Medicine 7/2015

01-07-2015 | Conference Reports and Expert Panel

Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric)

Authors: Cédric Bretonnière, Marc Leone, Christophe Milési, Bernard Allaouchiche, Laurence Armand-Lefevre, Olivier Baldesi, Lila Bouadma, Dominique Decré, Samy Figueiredo, Rémy Gauzit, Benoît Guery, Nicolas Joram, Boris Jung, Sigismond Lasocki, Alain Lepape, Fabrice Lesage, Olivier Pajot, François Philippart, Bertrand Souweine, Pierre Tattevin, Jean-François Timsit, Renaud Vialet, Jean Ralph Zahar, Benoît Misset, Jean-Pierre Bedos

Published in: Intensive Care Medicine | Issue 7/2015

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Abstract

Emerging resistance to antibiotics shows no signs of decline. At the same time, few new antibacterials are being discovered. There is a worldwide recognition regarding the danger of this situation. The urgency of the situation and the conviction that practices should change led the Société de Réanimation de Langue Française (SRLF) and the Société Française d’Anesthésie et de Réanimation (SFAR) to set up a panel of experts from various disciplines. These experts met for the first time at the end of 2012 and have since met regularly to issue the following 67 recommendations, according to the rigorous GRADE methodology. Five fields were explored: i) the link between the resistance of bacteria and the use of antibiotics in intensive care; ii) which microbiological data and how to use them to reduce antibiotic consumption; iii) how should antibiotic therapy be chosen to limit consumption of antibiotics; iv) how can antibiotic administration be optimized; v) review and duration of antibiotic treatments. In each institution, the appropriation of these recommendations should arouse multidisciplinary discussions resulting in better knowledge of local epidemiology, rate of antibiotic use, and finally protocols for improving the stewardship of antibiotics. These efforts should contribute to limit the emergence of resistant bacteria.
Appendix
Available only for authorised users
Footnotes
1
Thus, a strong recommendation in favour of an intervention reflects the panel’s opinion that the desirable effects of adherence to a recommendation (beneficial health outcomes, lesser burden on staff and patients, and cost savings) will clearly outweigh the undesirable effects (harm to health, more burden on staff and patients, and greater costs). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were taken into account. A weak recommendation in favour of an intervention indicates the judgment that the desirable effects of adherence to a recommendation probably will outweigh the undesirable effects, but the panel is not confident about these trade-offs either because some of the evidence is low quality (and thus uncertainty remains regarding the benefits and risks) or the benefits and downsides are closely balanced. A weak recommendation might also reflect uncertainty about whether the intervention represents a wise use of resources.
 
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Metadata
Title
Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric)
Authors
Cédric Bretonnière
Marc Leone
Christophe Milési
Bernard Allaouchiche
Laurence Armand-Lefevre
Olivier Baldesi
Lila Bouadma
Dominique Decré
Samy Figueiredo
Rémy Gauzit
Benoît Guery
Nicolas Joram
Boris Jung
Sigismond Lasocki
Alain Lepape
Fabrice Lesage
Olivier Pajot
François Philippart
Bertrand Souweine
Pierre Tattevin
Jean-François Timsit
Renaud Vialet
Jean Ralph Zahar
Benoît Misset
Jean-Pierre Bedos
Publication date
01-07-2015
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 7/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-015-3853-7

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High-dose versus standard dose oseltamivir for treatment of severe influenza in adult intensive care unit patients

Seven-Day Profile Publication

Intravenous amino acid therapy for kidney function in critically ill patients: a randomized controlled trial

Correspondence

Response to Lascarrou et al.: Coronary angiography after cardiac arrest: useful for whom?

Original

Plasma suPAR as a prognostic biological marker for ICU mortality in ARDS patients