Antimicrobial resistance and antibiotic stewardship programs in the ICU: insistence and persistence in the fight against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance
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Antimicrobial resistance (AMR) is a clear and present danger to patients in any intensive care unit (ICU) around the world. Whereas AMR may affect any patient in the hospital, patients in the ICU are particularly at risk of acquiring AMR infections due to the intensity of the treatment, use of invasive devices, increased risk of transmission and exposure to antibiotics. AMR is present in every ICU, although prevalence is geographically different and AMR pathogens encountered are variable. Intensive care and infectious disease specialists from the European Society of Intensive Care Medicine, European Society of Microbiology and Infectious Diseases and World Alliance Against Antimicrobial Resistance, united in the ANTARCTICA (Antimicrobial Resistance in Critical Care) coalition, call for increased awareness and action among health care professionals to reduce AMR development in critically ill patients, to improve treatment of AMR infections and to coordinate scientific research in this high-risk patient population. Close collaboration with other specialties, and combining these and other interventions in antibiotic stewardship programmes should be a priority in every ICU. Considerate antibiotic use and adopting strict infection control practices to halt AMR remains a responsibility shared by all healthcare workers, from physicians to maintenance personnel, from nurses to physiotherapists, from consultants to medical students. Together, we can reduce AMR in our ICUs and continue to treat our patients effectively.
KeywordsAntibiotic Resistance Stewardship Infection
JDW is supported by a Senior Clinical Investigator fellowship from the Research Foundation Flanders. JRB and RC receive funding for research from Plan Nacional de I+D+i 2013–2016 and Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001 and RD16/0016/0011, respectively)—co-financed by European Development Regional Fund “A way to achieve Europe”, Operative Programme Intelligent Growth 2014–2020. JAR wishes to recognise funding from the Australian National Health and Medical Research Council for a Centre of Research Excellence (APP1099452) and a Practitioner Fellowship (APP1117065).
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Conflicts of interest
Jan De Waele has consulted for Bayer Healthcare, Merck, and Pfizer. Murat Akova had received grants to support institutional research projects from Pfizer and MSD, and has participated accredited educational activities by Pfizer and Astellas. Massimo Antonelli received research grants from Orion, Toray, Pfizer and MSD, and received fees from GE, Maquet, Nihon Koden, Intersurgical and Orion for participation to International Boards. Rafael Canton has participated in educational programs sponsored by Angelini, AstraZeneca, Pfizer and MSD, and in research activities funded by AstraZeneca and MSD. Jean Carlet has participated in advisory boards with Beckton Dikinson, and has been a consultant for Cooper Alliance. George Dimopoulos has been a consultant for Bayer Healthcare, Merck, and Pfizer and Glenmark. José Garnacho-Montero has served as speaker for MSD, Astellas and has received research support from Astellas. Jozef Kesecioglu has received honorarium from Xenios AG. Jeff Lipman has consulted for Bayer and MSD. Mervyn Mer has participated in educational activities funded by MSD, Pfizer, Gilead, AstraZeneca, Sun Pharma. Jason Roberts has consulted for Astellas, bioMerieux and Bayer and has received investigator-initiated grant funding from MSD, Cardeas Pharma and The Medicines Company. Jesus Rodriguez-Bano has participated in research projects from AstraZeneca and InfectoPharm, and participated in accredited educational activities funded by Merck. Jean-Francois Timsit has participated in scientific boards of Bayer, Merck, Gilead, Paratek, Maat Pharma; the University Hospital of Jean-Francois Timsit received research grants from Merck, 3 M and Astellas and participated in advisory boards for 3 M, Merck, Gilead, Pfizer, Paratek, Bayer,. Jean-Ralph Zahar has consulted for Merck and Pfizer. The other authors state that they have no conflicts of interest. Matteo Bassetti has participated in advisory boards and/or received speaker honoraria from Achaogen, Angelini, Astellas, AstraZeneca, Bayer, Basilea, Gilead, Menarini, MSD, Pfizer, The Medicine Company, Tetraphase and Vifor.
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