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Vol. 47. Issue 2.
Pages 99-107 (February 2023)
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Vol. 47. Issue 2.
Pages 99-107 (February 2023)
Update in Intensive Care Medicine: Severe infections due to multi-resistant gram-negative bacilli
Antimicrobial stewardship programs in the Intensive Care Unit in patients with infections caused by multidrug-resistant Gram-negative bacilli
Programas de optimización de antibióticos en UCI en caso de Infecciones por Bacilos Gram-Negativos multi-resistentes
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J. Ruiz-Ramosa, P. Ramírezb,
Corresponding author
ramirez_pau@gva.es

Corresponding author.
a Servicio de Farmacia Hospitalaria, Hospital Santa Creu i Sant Pau, Barcelona, Spain
b Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
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Abstract

Antimicrobial stewardship programs (ASPs) have been shown to be effective and safe, contributing to reducing and adjusting antimicrobial use in clinical practice. Such programs not only reduce antibiotic selection pressure and therefore the selection of multidrug-resistant strains, but also reduce the potential deleterious effects for individual patients and even improve the prognosis by adjusting the choice of drug and dosage, and lessening the risk of adverse effects and interactions. Gram-negative bacilli (GNB), particularly multidrug-resistant strains (MDR-GNB), represent the main infectious problem in the Intensive Care Unit (ICU), and are therefore a target for ASPs. The present review provides an update on the relationship between ASPs and MDR-GNB.

Keywords:
Antibiotics
Resistance
De-escalation
Duration
Indicators
Resumen

Los programas de optimización del uso de antimicrobianos (PROAs) han demostrado ser una herramienta eficaz y segura que disminuye y ajusta el uso de antimicrobianos en la práctica clínica. El beneficio mostrado es doble, por un parte reduce la presión antibiótica y por tanto la selección de cepas multi-resistentes, y por otro disminuye los potenciales efectos deletéreos en el paciente concreto e incluso mejora el pronóstico al ajustar la elección del fármaco, la posología y los posible efectos adversos e interacciones. Los bacilos Gram-negativos (BGN), especialmente aquellas cepas con mecanismos de resistencia (BGN-MDR), representan el principal problema infeccioso en las unidades de cuidados intensivos y por tanto son el objetivo de los PROAs. En la siguiente revisión actualizaremos aquellos aspectos que combinan y justifican la relación entre los PROAs y los BGN-MDR.

Palabras clave:
Antibióticos
Resistencia
Desescalada
Duración
Indicadores

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