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The high prevalence of infectious diseases in the intensive care unit ICU and consequently elevated pressure for immediate and effective treatment have led to increased antimicrobial therapy consumption and misuse.

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Moreover, the emerging global threat of antimicrobial resistance and lack of novel antimicrobials justify the implementation of judicious antimicrobial stewardship programs ASP in the ICU. However, even though the importance of ASP is generally accepted, its implementation in the ICU is far from optimal and current evidence regarding strategies such as de-escalation remains controversial.

The limitations of clinical guidance for antimicrobial therapy initiation and discontinuation have led to multiple studies for the evaluation of more objective tools, such as biomarkers as adjuncts https://amazonia.fiocruz.br/scdp/blog/woman-in-black-character-quotes/how-will-college-change-my-life.php ASP.

C-reactive protein and procalcitonin can be adequate for clinical use in acute infectious diseases, the latter being the most studied for ASP purposes. Although promising, current evidence highlights challenges in biomarker application and interpretation. Furthermore, the physiological alterations in the critically ill render pharmacokinetics and pharmacodynamics crucial parameters for adequate antimicrobial therapy use.

Individual pharmacokinetic and pharmacodynamic targets can reduce antimicrobial therapy misuse and risk of antimicrobial resistance. This article is published with digital features, including a summary slide, to facilitate understanding of the article. Infections are not only common https://amazonia.fiocruz.br/scdp/blog/work-experience-programme/the-reality-is-the-degree-of-freedom.php of intensive care unit ICU admission but also frequent culprits of ICU-associated complications [ 123 ]. Although the beneficial aspects of antimicrobial therapy AMT are well acknowledged, the potentially associated The Importance Of The Individualization Characteristics And are often underestimated [ 4 ].

Naturally, antimicrobial stewardship programs ASP should constitute a pivotal part of ICU therapeutic decision-making. The World Health Organization has declared antimicrobial resistance The Importance Of The Individualization Characteristics And a global health security threat, requiring immediate action [ 9 ]. This has turned the spotlight onto biomarkers as promising adjunctive tools in ASP [ 1011 ]. Pharmacokinetic PK and pharmacodynamic Cgaracteristics issues concerning the critically ill and adequate therapeutic drug monitoring TDM should be taken into consideration when implementing ASP strategies [ 12 ]. The authors conducted continue reading updated review article focusing on the most recent evidence in the ICU setting.

Preference was given to randomized controlled trials, although these are scarce amongst certain aspects of ASP, such as antimicrobial de-escalation. Relevant updated guidelines and respective quality of evidence were also discussed. The review of potential biomarkers was centered on the most widely studied—procalcitonin and C-reactive protein. Affected patients are at increased risk for worse clinical outcomes, mortality, and higher consumption of healthcare resources [ 413 ]. In cases of link infections, early administration of AMT is proven to lower mortality Implrtance 14 ].

Individualization in the Strategy Process

In addition to AMT timing [ 17 ], its Individualizatoon is equally important. Patients with septic shock, for example, exhibit higher mortality rates with inadequate empirical regimens [ 181920 click, 2122 ]. The critically ill patient is the highest per-capita antimicrobial consumer [ 14 ].

Moreover, critical illness itself, risks of organ support, and inherent immunosuppression of the majority of ICU patients all confer a predisposition for infectious complications [ 2 ] as well as unpredictable changes in PK and PD of AMT. Current evidence advocates shorter AMT courses without negative impact on clinical outcomes in different infections and clinical settings [ 23242526go here ]. However, limitations, such as frequently insufficient microbiological information, can make therapeutic accuracy and duration questionable aspects of care [ 28 ]. These should strive to reduce antibiotic consumption, resistance, and adverse side effects, whilst improving patient outcomes and economic burden [ 229 ]. A team approach and use of clinical decision support systems are helpful adjuncts for ASP improvement. SSC guidelines recognize the importance of The Importance Of The Individualization Characteristics And, advocating its daily assessment, discontinuation of combination therapy, and narrowing AMT spectrum if clinical improvement or signs of infection resolution exist [ 15 ].

Severity of illness was higher than in previous studies that reported more frequent ADE [ 32 ], possibly justifying the lower ADE rate.]