Intensive Care Medicine

, Volume 44, Issue 2, pp 189–196 | Cite as

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

  • Jan J. De WaeleEmail author
  • Murat Akova
  • Massimo Antonelli
  • Rafael Canton
  • Jean Carlet
  • Daniel De Backer
  • George Dimopoulos
  • José Garnacho-Montero
  • Jozef Kesecioglu
  • Jeffrey Lipman
  • Mervyn Mer
  • José-Artur Paiva
  • Mario Poljak
  • Jason A. Roberts
  • Jesus Rodriguez Bano
  • Jean-François Timsit
  • Jean-Ralph Zahar
  • Matteo Bassetti
Conference Reports and Expert Panel


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.


Antibiotic 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).

Compliance with ethical standards

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.

Supplementary material

134_2017_5036_MOESM1_ESM.docx (29 kb)
Supplementary material 1 (DOCX 12 kb)


  1. 1.
    Tabah A, Koulenti D, Laupland K, Misset B, Valles J, de Bruzzi Carvalho F, Paiva JA, Cakar N, Ma X, Eggimann P, Antonelli M, Bonten MJ, Csomos A, Krueger WA, Mikstacki A, Lipman J, Depuydt P, Vesin A, Garrouste-Orgeas M, Zahar JR, Blot S, Carlet J, Brun-Buisson C, Martin C, Rello J, Dimopoulos G, Timsit JF (2012) Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 38:1930–1945CrossRefPubMedGoogle Scholar
  2. 2.
    O’Neill J (2014) Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Rev Antimicrob Resist 1–16Google Scholar
  3. 3.
    Bassetti M, Poulakou G, Ruppe E, Bouza E, Van Hal SJ, Brink A (2017) Antimicrobial resistance in the next 30 years, humankind, bugs and drugs: a visionary approach. Intensive Care Med 43:1464–1475CrossRefPubMedGoogle Scholar
  4. 4.
    Bassetti M, De Waele JJ, Eggimann P, Garnacho-Montero J, Kahlmeter G, Menichetti F, Nicolau DP, Paiva JA, Tumbarello M, Welte T, Wilcox M, Zahar JR, Poulakou G (2015) Preventive and therapeutic strategies in critically ill patients with highly resistant bacteria. Intensive Care Med 41:776–795CrossRefPubMedGoogle Scholar
  5. 5.
    Martín-Loeches I, Diaz E, Vallés J (2014) Risks for multidrug-resistant pathogens in the ICU. Curr Opin Crit Care 20:516–524CrossRefPubMedGoogle Scholar
  6. 6.
    Miller BM, Johnson SW (2016) Demographic and infection characteristics of patients with carbapenem-resistant Enterobacteriaceae in a community hospital: development of a bedside clinical score for risk assessment. Am J Infect Control 44:134–137CrossRefPubMedGoogle Scholar
  7. 7.
    Bassetti M, Carnelutti A, Peghin M (2017) Patient specific risk stratification for antimicrobial resistance and possible treatment strategies in gram-negative bacterial infections. Expert Rev Anti-infect Ther 15:55–65CrossRefPubMedGoogle Scholar
  8. 8.
    van Belkum A, Durand G, Peyret M, Chatellier S, Zambardi G, Schrenzel J, Shortridge D, Engelhardt A, Dunne WM (2013) Rapid clinical bacteriology and its future impact. Ann Lab Med 33:14–27CrossRefPubMedGoogle Scholar
  9. 9.
    Barbier F, Pommier C, Essaied W, Garrouste-Orgeas M, Schwebel C, Ruckly S, Dumenil AS, Lemiale V, Mourvillier B, Clec’h C, Darmon M, Laurent V, Marcotte G, Lucet JC, Souweine B, Zahar JR, Timsit JF, Outcomerea SG (2016) Colonization and infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in ICU patients: what impact on outcomes and carbapenem exposure. J Antimicrob Chemother 71:1088–1097CrossRefPubMedGoogle Scholar
  10. 10.
    Bassetti M, Righi E, Carnelutti A (2016) New therapeutic options for respiratory tract infections. Curr Opin Infect Dis 29:178–186CrossRefPubMedGoogle Scholar
  11. 11.
    Roberts JA, Lefrant JY, Lipman J (2017) What’s new in pharmacokinetics of antimicrobials in AKI and RRT. Intensive Care Med 43:904–906CrossRefPubMedGoogle Scholar
  12. 12.
    Tängdén T, Ramos Martín V, Felton TW, Nielsen EI, Marchand S, Brüggemann RJ, Bulitta JB, Bassetti M, Theuretzbacher U, Tsuji BT, Wareham DW, Friberg LE, De Waele JJ, Tam VH, Roberts JA, Infection Section for the European Society of Intensive Care Medicine TPAPSGOTESOCMAID, the International Society of Anti-Infective Pharmacology and the Critically Ill Patients Study Group of European Society of Clinical Microbiology and Infectious Diseases (2017) The role of infection models and PK/PD modelling for optimising care of critically ill patients with severe infections. Intensive Care Med 43:1021–1032CrossRefPubMedGoogle Scholar
  13. 13.
    Tabah A, De Waele J, Lipman J, Zahar JR, Cotta MO, Barton G, Timsit JF, Roberts JA, Working Group for Antimicrobial Use in the ICU within the Infection Section of the European Society of Intensive Care Medicine ESICM (2015) The ADMIN-ICU survey: a survey on antimicrobial dosing and monitoring in ICUs. J Antimicrob Chemother 70:2671–2677CrossRefPubMedGoogle Scholar
  14. 14.
    Dimopoulos G, Poulakou G, Pneumatikos IA, Armaganidis A, Kollef MH, Matthaiou DK (2013) Short- vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis. Chest 144:1759–1767CrossRefPubMedGoogle Scholar
  15. 15.
    Matthaiou DK, Ntani G, Kontogiorgi M, Poulakou G, Armaganidis A, Dimopoulos G (2012) An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic therapy algorithms in adult critically ill patients. Intensive Care Med 38:940–949CrossRefPubMedGoogle Scholar
  16. 16.
    de Jong E, van Oers JA, Beishuizen A, Vos P, Vermeijden WJ, Haas LE, Loef BG, Dormans T, van Melsen GC, Kluiters YC, Kemperman H, van den Elsen MJ, Schouten JA, Streefkerk JO, Krabbe HG, Kieft H, Kluge GH, van Dam VC, van Pelt J, Bormans L, Otten MB, Reidinga AC, Endeman H, Twisk JW, van de Garde EM, de Smet AM, Kesecioglu J, Girbes AR, Nijsten MW, de Lange DW (2016) Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis 16:819–827CrossRefPubMedGoogle Scholar
  17. 17.
    Holmes AH, Moore LS, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, Guerin PJ, Piddock LJ (2016) Understanding the mechanisms and drivers of antimicrobial resistance. Lancet 387:176–187CrossRefPubMedGoogle Scholar
  18. 18.
    Derde LP, Cooper BS, Goossens H, Malhotra-Kumar S, Willems RJ, Gniadkowski M, Hryniewicz W, Empel J, Dautzenberg MJ, Annane D, Aragao I, Chalfine A, Dumpis U, Esteves F, Giamarellou H, Muzlovic I, Nardi G, Petrikkos GL, Tomic V, Marti AT, Stammet P, Brun-Buisson C, Bonten MJ (2014) Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis 14:31–39CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Paterson DL (2004) Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis 38(Suppl 4):S341–S345CrossRefPubMedGoogle Scholar
  20. 20.
    Brooks BD, Brooks AE (2014) Therapeutic strategies to combat antibiotic resistance. Adv Drug Deliv Rev 78:14–27CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2017

Authors and Affiliations

  • Jan J. De Waele
    • 1
    Email author
  • Murat Akova
    • 2
  • Massimo Antonelli
    • 3
  • Rafael Canton
    • 4
  • Jean Carlet
    • 5
  • Daniel De Backer
    • 6
  • George Dimopoulos
    • 7
  • José Garnacho-Montero
    • 8
  • Jozef Kesecioglu
    • 9
  • Jeffrey Lipman
    • 10
    • 11
  • Mervyn Mer
    • 11
    • 12
  • José-Artur Paiva
    • 13
  • Mario Poljak
    • 14
  • Jason A. Roberts
    • 15
  • Jesus Rodriguez Bano
    • 16
  • Jean-François Timsit
    • 17
    • 18
  • Jean-Ralph Zahar
    • 18
    • 19
  • Matteo Bassetti
    • 20
  1. 1.Department of Critical Care MedicineGhent University HospitalGhentBelgium
  2. 2.Department of Infectious DiseasesHacettepe University School of MedicineAnkaraTurkey
  3. 3.Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. GemelliUniversità Cattolica del Sacro CuoreRomeItaly
  4. 4.Servicio de Microbiología, Hospital Universitario Ramón y CajalInstituto Ramón y Cajal de Investigación Sanitaria (IRYCIS)MadridSpain
  5. 5.World Alliance Against Antibiotic Resistance (WAAAR)CreteilFrance
  6. 6.Department of Intensive Care, CHIREC HospitalsUniversité Libre de BruxellesBrusselsBelgium
  7. 7.Department of Critical Care, Medical SchoolUniversity Hospital ATTIKON, National and Kapodistrian University of AthensAthensGreece
  8. 8.Intensive Care Clinical UnitVirgen Macarena University HospitalSevilleSpain
  9. 9.Department of Intensive Care MedicineUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
  10. 10.Royal Brisbane and Womens’ HospitalThe University of QueenslandBrisbaneAustralia
  11. 11.Wits-UQ Critical Care Infection CollaborationJohannesburgSouth Africa
  12. 12.Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
  13. 13.Grupo de Infecçao e Sépsis, Department of Emergency and Intensive Care, Facuilty of Medicine, Centro Hospitalar Sao JoaoUniversity of PortoPortoPortugal
  14. 14.Faculty of Medicine, Institute of Microbiology and ImmunologyUniversity of LjubljanaLjubljanaSlovenia
  15. 15.Faculty of Medicine and Centre for Translational Anti-infective PharmacodynamicsThe University of QueenslandBrisbaneAustralia
  16. 16.Unidad Clínica de Enfermedades Infecciosas, Departamento de Medicina, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de SevillaUniversidad de Sevilla/CSICSevilleSpain
  17. 17.Réanimation Medicale et des Maladies InfectieusesUniversité Paris Diderot/Hopital BichatParisFrance
  18. 18.IAME, UMR 1137, Université Paris 13Sorbonne Paris CitéFrance
  19. 19.Unité de Contrôle et de Prévention du Risque Infectieux, Département de Microbiologie CliniqueGroupe Hospitalier Paris Seine Saint-DenisBobignyFrance
  20. 20.Infectious Diseases Clinic, Department of Medicine University of UdineAzienda Sanitaria Universitaria IntegrataUdineItaly

Personalised recommendations