Intensive Care Medicine

, Volume 42, Issue 12, pp 2034–2036 | Cite as

Alternatives to antibiotics

  • Bruno François
  • Hasan S. Jafri
  • Marc Bonten
What's New in Intensive Care

Infection remains one of the main reasons for admission to intensive care units (ICU). As a consequence, more than 60 % of ICU patients receive antibiotics during their stay in the ICU [1], despite implementation of antibiotic stewardship programs to improve the quality of antibiotic use [2, 3]. In most countries antibiotic consumption is mainly driven by pulmonary infections, such as community acquired pneumonia (CAP), healthcare associated pneumonia (HCAP), hospital acquired pneumonia (HAP), and ventilator associated pneumonia (VAP). Bacterial resistance has concurrently increased, especially for Gram negative bacilli, including Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii, while prevalence of methicillin resistance among Staphylococcus aureus has remained stable or declined in most European countries [4]. Yet, very few new antibiotics have been developed over the past decade and only a few novel drugs are in the development pipeline of pharmaceutical...


Intensive Care Unit Intensive Care Unit Patient Ventilator Associate Pneumonia Acinetobacter Baumannii Intensive Care Unit Setting 
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Compliance with ethical standards

Conflicts of interest

Bruno Francois is the coordinating principal investigator of an ongoing international phase II trial testing a monoclonal antibody against S. aureus to prevent VAP in ICU patients in collaboration with Medimmune, a member of the AstraZeneca group. No other conflict of interest related to this manuscript to declare. Hasan Jafri is an employee of MedImmune, AstraZeneca, the manufacturer of anti-infectious disease monoclonal antibodies. He is currently leading the development and conduct of studies focused on prevention of nosocomial pneumonia, using monoclonal antibodies targeting S. aureus and P. aeruginosa. No other conflict of interest related to this manuscript to declare. Marc Bonten is a member of the study team of an ongoing international phase II trial testing a monoclonal antibody against S. aureus to prevent VAP in ICU patients in collaboration with Medimmune, a member of the AstraZeneca group, as part of the IMI-funded COMBACTE and COMBACTE MAGNET projects. No other conflict of interest related to this manuscript to declare.


  1. 1.
    Bergmans DC, Bonten MJ, Gaillard CA, van Tiel FH, van der Geest S, de Leeuw PW, Stobberingh EE (1997) Indications for antibiotic use in ICU patients: a one-year prospective surveillance. J Antimicrob Chemother 39:527–535CrossRefPubMedGoogle Scholar
  2. 2.
    Allerberger F, Gareis R, Jindrak V, Struelens MJ (2009) Antibiotic stewardship implementation in the EU: the way forward. Expert Rev Anti Infect Ther 7:1175–1183CrossRefPubMedGoogle Scholar
  3. 3.
    Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Pediatric Infectious Diseases Society (2012) Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 33:322–327CrossRefGoogle Scholar
  4. 4.
    European Centre for Disease Prevention and Control (2015) Annual epidemiological report 2014. Antimicrobial resistance and healthcare-associated infections. ECDC, Stockholm. Accessed 11 Feb 2016
  5. 5.
    Czaplewski L, Bax R, Clokie M, Dawson M, Fairhead H, Fischetti VA et al (2016) Alternatives to antibiotics—a pipeline portfolio review. Lancet Infect Dis 16(2):239–251CrossRefPubMedGoogle Scholar
  6. 6.
    Timsit JF, Perner A, Bakker J, Bassetti M, Benoit D, Cecconi M et al (2015) Year in review in Intensive Care Medicine 2014: III. Severe infections, septic shock, healthcare-associated infections, highly resistant bacteria, invasive fungal infections, severe viral infections, Ebola virus disease and paediatrics. Intensive Care Med 41(4):575–588CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT et al (2013) Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis 13(8):665–671CrossRefPubMedGoogle Scholar
  8. 8.
    Que Y, Lazar H, Wolff M, Francois B, Laterre PF, Mercier E, Garbino J, Pagani JL, Revelly JP, Mus E, Perez A, Tamm M, Rouby JJ, Lu Q, Chastre J, Eggimann P (2014) Assessment of panobacumab as adjunctive immunotherapy for the treatment of nosocomial Pseudomonas aeruginosa pneumonia. Eur J Clin Microbiol Infect Dis 33(10):1861–1867CrossRefPubMedGoogle Scholar
  9. 9.
    Francois B, Luyt CE, Dugard A, Wolff M, Diehl J, Jaber S, Forel JM, Garot D, Kipnis E, Mebazaa A, Misset B, Andremont A, Ploy MC, Jacobs A, Yarranton G, Pearce T, Fagon JY, Chastre J (2012) Safety and pharmacokinetics of an anti-PcrV PEGylated monoclonal antibody fragment in mechanically ventilated patients colonized with Pseudomonas aeruginosa: a randomized, double-blind, placebo-controlled trial. Crit Care Med 40(8):2320–2326CrossRefPubMedGoogle Scholar
  10. 10.
    DiGiandomenico A, Keller AE, Gao C, Rainey GJ, Warrener P, Camara MM, Bonnell J, Fleming R, Bezabeh B, Dimasi N, Sellman BR, Hilliard J, Guenther CM, Datta V, Zhao W, Gao C, Yu XQ, Suzich JA, Stover CK (2014) A multifunctional bispecific antibody protects against Pseudomonas aeruginosa. Sci Transl Med 6(262):262ra155CrossRefPubMedGoogle Scholar
  11. 11.
    Berube BJ, Bubeck Wardenburg J (2013) Staphylococcus aureus α-toxin: nearly a century of intrigue. Toxins (Basel) 5(6):1140–1166CrossRefGoogle Scholar
  12. 12.
    Pirnay JP, Blasdel BG, Bretaudeau L, Buckling A, Chanishvili N, Clark JR et al (2015) Quality and safety requirements for sustainable phage therapy products. Pharm Res 32:2173–2179CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Sansom C (2015) Phage therapy for severe infections tested in the first multicentre trial. Lancet Infect Dis 15(12):1384–1385CrossRefPubMedGoogle Scholar
  14. 14.
    Coulter LB, McLean RJ, Rohde RE, Aron GM (2014) Effect of bacteriophage infection in combination with tobramycin on the emergence of resistance in Escherichia coli and Pseudomonas aeruginosa biofilms. Viruses 6(10):3778–3786CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Shaw KJ, Lehman SM, Smrekar F, Weiss WJ, Pulse M, Morales SP (2015) Efficacy of a bacteriophage cocktail in a Staphylococcus aureus mouse pneumonia model is comparable to vancomycin. Poster presentation, ICAAC/ICC 2015, San DiegoGoogle Scholar
  16. 16.
    Cooper CJ, Denyer SP, Maillard JY (2014) Stability and purity of a bacteriophage cocktail preparation for nebulizer delivery. Lett Appl Microbiol 58:118–122CrossRefPubMedGoogle Scholar
  17. 17.
    Sahota JS, Smith CM, Radhakrishnan P, Winstanley C, Goderdzishvili M, Chanishvili N, Kadioglu A, O’Callaghan C, Clokie MR (2015) Bacteriophage delivery by nebulization and efficacy against phenotypically diverse Pseudomonas aeruginosa from cystic fibrosis patients. J Aerosol Med Pulm Drug Deliv 28(5):353–360CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Bruno François
    • 1
    • 2
  • Hasan S. Jafri
    • 3
  • Marc Bonten
    • 4
  1. 1.Service de Réanimation PolyvalenteCHU DupuytrenLimoges CedexFrance
  2. 2.Inserm CIC 1435 and UMR 1092LimogesFrance
  3. 3.MedimmuneGaithersburgUSA
  4. 4.Department of Medical Microbiology and Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands

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