Review on strategies to minimize the appearance of multi-drug resistant organism

Frutos Pérez-Surio, Alberto ; Gastón Añaños, Juan ; Sahún García, Elisa ; Sancho Monllor, Gema

Resumen: Background: The use of antibiotic drugs (ABX) in hospitals, and especially in intensive care units (ICU), is widespread. The early administration of ABX therapy can improve survival rates. The in uence and impact of the ABX are observed in the patients who receive them (clinical response, course) and in the ecosystem surrounding the patient (hospital ora).
Aim of the review: The objective of this review is to identify strategies that reduce or limit the appearance and transmission of multidrug-resistant microorganisms. This identi - cation can then develop a rational use of the ABX plan in the ICU.
Method: The following databases were queried; Medline, Embase, The Cochrane Library, and the Centre for Reviews and Dissemination (University of York), asking the questions in PICO format to evaluate the e cacy and safety of several inter- ventions: A) Therapeutic de-escalation; B) Cycling of ABX and; C) Early antibiotic treatment.
Results: A) In therapeutic de-escalation of 98 studies identi ed, three studies that met the inclusion criteria were analyzed. B) Two studies comparing antibiotic cycling versus other inter- ventions were selected. C) No studies have been found with su ciently robust methodological designs that address the ABX early treatment. There is no strong evidence to indicate which of the di erent antibiotic interventions (therapeutic de-escalation, cycling of ABX and preemptive treatment) is more e ective in reducing antibiotic resistance in ICU patients. There is insu cient evidence that de-escalation of antimicrobial agents is e ective against resistance. In patients admitted to the ICU with a low prevalence of uoroquinolones resistance, increased exposure to this class of antibiotics, using antibiotic cycling, increases the emergence of resistant strains.
Conclusion: Despite the fact that no prospective studies were identi ed in this SR, rationale and day-to-day clinical prac- tice experience suggest that multidisciplinary participation of di erent specialists in ABX's Infection and Policy Commission (or the ABX Commission), or the Pharmacy and Therapeutics Committee, might improve the develop- ment and application of these strategies.

Idioma: Inglés

DOI: 10.29251/ijpph.201874

Año: 2018

Publicado en: International journal of perceptions in public health 2, 3 (2018), 141-150
ISSN: 2399-8164

Tipo y forma: Artículo (Versión definitiva)