Implementing an Antimicrobial Stewardship Program and Complete Screening in an Intensive Care Unit in Relation to the Overall Clinical Outcome of Patients.

Abstract

Background: The high prevalence of resistant microorganisms indicates a multidisciplinary approach, which will ensure efficiency and balance between resistance therapy of choice and the implementation of an antimicrobial stewardship (AMS) program in intensive unit care (ICU).

Objectives: The objectives are based on the assessment of AMS in a cardiac surgical intensive care unit (CICU), by determination with the reduction of: inotropic support, length of antibiotic treatment, and need for renal replacement therapy (RRT).

Material and methods: The research is a retrospective, group comparative, analytical cross-sectional study, in the period from 2020-2023, within the Cardiosurgery department, at Acibadem Sistina. 1277 patients participated in the research, divided into two groups: group 1 (2020-2021) and group 2 (2022-2023). Primary endpoints investigated: inotropic support, need for RRT and length of antibiotic treatment. Secondary endpoints investigated: optimization of antibiotic therapeutic regimen and clinical outcome assessment of patients (survival).

Results: The inotropic support during 24, 48 and 72 h was statistically significantly lower in group 2. A statistically significant shorter length of time for antibiotic treatment was determined in patients in group 2 (p=0.000), as well as a lower value of the need for RRT. A statistically significant difference in time to event (fatal outcome) was determined between the two groups (p=0.000). A significant difference (p=0.000) was determined in the prescription and optimization of the therapeutic regimen.

Conclusion: Integrating AMS, initial comprehensive microbiological screening and application of biomarkers in the CICU, established appropriately, will result in improved overall clinical outcome for patients.