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Managing antimicrobial resistance in intensive care units

Gandhi, Tejal N. MD; DePestel, Daryl D. PharmD; Collins, Curtis D. PharmD, MS; Nagel, Jerod PharmD; Washer, Laraine L. MD

doi: 10.1097/CCM.0b013e3181e6a2a4
Specific Infection Control Topics

The challenges in managing patients with infection in the intensive care unit are increased in an era where there are dwindling antimicrobial choices for multidrug-resistant pathogens. Clinicians in the intensive care unit must balance between choosing appropriate antimicrobial treatment for patients with suspected infection and utilizing antimicrobials in a judicious fashion. Improving antimicrobial utilization is a critical component to reducing antimicrobial resistance. Although providing effective antimicrobial therapy and improving antimicrobial utilization may seem to be competing goals, there are effective strategies to accomplish both. Antimicrobial stewardship programs provide an organized way to implement these strategies and can enhance the intensive care unit physician's success in improving patient outcomes and combating antimicrobial resistance in the intensive care unit.

From the Department of Internal Medicine (TNG, LLW), Division of Infectious Diseases, University of Michigan, Ann Arbor, MI; Department of Clinical, Social and Administrative Sciences (DDD), University of Michigan College of Pharmacy, Ann Arbor, MI; Department of Pharmacy Services (DDD, CDC, JN), University of Michigan, Ann Arbor, MI; and the Department of Infection Control and Hospital Epidemiology (LLW), University of Michigan, Ann Arbor, MI.

Dr. DePestel has disclosed that he has received grants and research funds from Cubist Pharmaceuticals, Merck, and Pfizer as well as honoraria from Astellas, Cubist Pharmaceuticals, Johnson & Johnson, Merck, and Wyeth. Dr. Collins has received a grant from Cubist Pharmaceuticals. The remaining authors have not disclosed any potential conflicts of interest.

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© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins