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Intensive Care Medicine
Published in: Intensive Care Medicine 2/2020

01-02-2020 | Care | Narrative Review

Antimicrobial-associated harm in critical care: a narrative review

Authors: Nishkantha Arulkumaran, Matthew Routledge, Sanmarié Schlebusch, Jeffrey Lipman, Andrew Conway Morris

Published in: Intensive Care Medicine | Issue 2/2020

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Abstract

The belief that, for the individual patient, the benefit of prompt and continued use of antimicrobials outweighs any potential harm is a significant barrier to improved stewardship of these vital agents. Antimicrobial stewardship may be perceived as utilitarian rationing, seeking to preserve the availability of effective antimicrobials by limiting the development of resistance in a manner which could conflict with the immediate treatment of the patient in need. This view does not account for the growing evidence of antimicrobial-associated harm to individual patients. This review sets out the evidence for antimicrobial-associated harm and how this should be balanced with the need for prompt and appropriate therapy in infection. It describes the mechanisms by which antimicrobials may harm patients including: mitochondrial toxicity; immune cell toxicity; adverse drug reactions; selection of resistant organisms within a given patient; and disruption of the microbiome. Finally, the article indicates how the harms of antimicrobials may be mitigated and identifies areas for research and development in this field.
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Metadata
Title
Antimicrobial-associated harm in critical care: a narrative review
Authors
Nishkantha Arulkumaran
Matthew Routledge
Sanmarié Schlebusch
Jeffrey Lipman
Andrew Conway Morris
Publication date
01-02-2020
Publisher
Springer Berlin Heidelberg
Keyword
Care
Published in
Intensive Care Medicine / Issue 2/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-020-05929-3

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