Antimicrobial stewardship in the intensive care setting

Intensive care units (ICUs) care for patients with life-threatening infections and thus harbour reservoirs of pathogenic microorganisms. Furthermore, as a direct consequence of their critical illness/injury, ICU patients commonly have a significant degree of acutely acquired, innate, and adaptive immune system dysfunction. Critically ill patients therefore present unique challenges for antibiotic stewardship. Antibiotic stewardship in ICUs should address both the timely delivery of effective empiric therapy and the minimization of the use of broad-spectrum agents. Solutions to these challenges are usually adaptations of general principles rather than novel interventions. In ICUs, as elsewhere, antibiotic stewardship should be viewed as a key component of the overall infection control strategy.