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Infect Dis Clin North Am. 2017 Sep;31(3):513-534. doi: 10.1016/j.idc.2017.05.002. Epub 2017 Jul 5.

Antimicrobial Stewardship Approaches in the Intensive Care Unit.

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Division of Infectious Diseases, Department of Medicine, University of California, 513 Parnassus Avenue, Box 0654, San Francisco, CA 94143, USA. Electronic address:
Division of Infectious Diseases, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, Room 3400, Building 30, 1001 Potrero Avenue, San Francisco, CA 94110, USA.


Antimicrobial stewardship programs aim to monitor, improve, and measure responsible antibiotic use. The intensive care unit (ICU), with its critically ill patients and prevalence of multiple drug-resistant pathogens, presents unique challenges. This article reviews approaches to stewardship with application to the ICU, including the value of diagnostics, principles of empirical and definitive therapy, and measures of effectiveness. There is good evidence that antimicrobial stewardship results in more appropriate antimicrobial use, shorter therapy durations, and lower resistance rates. Data demonstrating hard clinical outcomes, such as adverse events and mortality, are more limited but encouraging; further studies are needed.


Antibacterial resistance; Antimicrobial stewardship; Clostridium difficile infection; Computerized decision support; Formulary restriction; Prospective audit and feedback; Rapid diagnostics

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