Strategies Against Resistance & Stewardship

Sepsis and septic shock are important problems in critical care medicine as they are frequent, challenging to treat, and associated with high morbidity and mortality rates. Key factors in sepsis therapy include fluid resuscitation, support of failing organs, administration of antibiotics and source control.

Given the impact of early and broad-spectrum empirical therapy in several studies and the emphasis placed on this in international guidelines, there is a low threshold for initiating antibiotics in many patients with a suspected infection. This has led to the widespread use of antibiotics in sick patients, which is often unnecessary or inappropriate.

In recent decades, the problem of antimicrobial resistance has increased significantly worldwide, and the World Economic Forum has identified antimicrobial resistance as one of the main threats to healthcare. Numerous initiatives have been launched to combat antimicrobial resistance, and decreasing the use of antibiotics is a priority, as this is clearly linked to the problem of antimicrobial resistance. One of the strategies that have been developed as a response to increasing rates of antimicrobial resistance is the implementation of antimicrobial stewardship programs in acute care hospitals.

Antimicrobial stewardship attempts to reduce antibiotic exposure while improving outcomes and may intuitively contrast with current antibiotic prescription practices. The challenge for physicians is thus to correctly diagnose infection and improve outcomes while reducing antibiotic use. This can be done by adhering to local guidelines for empirical therapy, better risk for multidrug resistance assessment, optimized antibiotic dosing, and integration of rapid diagnostic techniques in the decision-making process. Watchful waiting, or withholding antibiotics until the infection is confirmed, is justified in non-severely ill patients in whom the clinical picture is not clear.

In this lecture, Jan J. De Waele explains how different antimicrobial resistances are produced and how this problem can be improved by integrating antimicrobial stewardship strategies in clinical practice, upholding the best empirical antibiotic therapy while reducing antibiotic consumption.