ICU Management & Practice, Volume 22 - Issue 4, 2022 Diagnostic Stewardship in Five Common Infectious Syndromes This article defines diagnostic stewardship and discusses how it can be implemented in intensive care units and how it may improve patient outcomes. Introduction Antimicrobial resistance (AMR) is an imminent threat to global health and has been accelerated by the inappropriate use of antimicrobials (Llor and Bjerrum 2014). Antimicrobial stew...

ICU Management & Practice, Volume 22 - Issue 4, 2022 Rapid Diagnostics and Antimicrobial Resistance in the ICU The need to address the problem of antimicrobial resistance, the importance of faster diagnosis of bacterial infections and an overview of rapid diagnostic testing. Antimicrobial resistance (AMR) is rapidly increasing on a global scale. The discovery of penicillin revolutionised the field of medicine, providing safe harbour from the most pressin...

ICU Management & Practice, Volume 22 - Issue 4, 2022 Does Antimicrobial Resistance Affect Clinical Outcomes in the ICU? An overview of antimicrobial resistance and its impact on clinical outcomes in the ICU.  Antimicrobial resistance (AMR) has been defined as a major threat to healthcare and to humanity by the World Health Organization (WHO 2015). The level of evidence for the association between AMR and hospital deaths, hospital length of stay and ...

Editorial  February 7, 2023 Manufacturer Spending on Direct-to-Consumer Advertising for Pharmaceutical Products Amanda Starc JAMA. 2023;329(5):371-373. doi:10.1001/jama.2022.24078 The tension between physicians and drugmakers, especially over marketing, dates to the era of patent medicines.1 Since 1997, pharmaceutical manufacturers have advertised directly to US consumers, amplifying controversy over the role of drug marketing in clinica...

ICU Management & Practice, Volume 22 - Issue 4, 2022 Multidrug-Resistant Gram-Negative Bacteria in the ICU Severe infections by antibiotic resistant gram-negative bacteria are frequent in ICU patients. They are associated with high morbidity and mortality. Introduction Bacterial infections in patients hospitalised in the Intensive Care Unit (ICU) are frequent, and they elicit an increase in morbidity and mortality. The emerging development of antibiot...

Optimised Prediction of All-Cause Mortality of ICU Patients Outcomes research on ICU patients requires accurate measures of comorbidity to predict mortality. The Simplified Acute Physiology Score (SAPS3) is widely used and provides some information on comorbidity. The Charlson comorbidity index (CCI) uses general comorbidity measures and may not be sufficiently discriminative. These risk scores use the presence of comorbidity as binary variables but disregard quant...

ICU Management & Practice, Volume 22 - Issue 4, 2022 Antibiotic Stewardship in Critical and Emergency Care An overview of antimicrobial stewardship in critical care units and emergency departments, highlighting aspects to reduce multidrug resistance focusing on antibiotic optimisation in respiratory infections and sepsis. Introduction Infections caused by resistant bacteria are associated with higher treatment costs and increased morbidity and mortali...

ICU Management & Practice, Volume 22 - Issue 4, 2022 Pancreatic Stone Protein Biomarker for Sepsis, Antimicrobial Resistance and Nosocomial Infections The problem of antimicrobial resistance and the use of a clinical decision score and point-of-care testing biomarkers, such as CRP and PSP, to help solve this problem.  Introduction  Infectious diseases are a public health issue around the world, with bacterial, viral, parasitic, or fungal-rel...

ICU Management & Practice, Volume 22 - Issue 4, 2022 Pharmacokinetic/Pharmacodynamic Principles to Combat Antimicrobial Resistance Pharmacodynamic and pharmacokinetic principles play a central role in antimicrobial dose-optimisation to combat antimicrobial resistance. In the future, research focused on the integration of preclinical and clinical data is paramount. Antimicrobial Resistance in the ICU The use of antimicrobial drugs in the hospital is ve...

Quality of Life, Costs, Economic Evaluation in ECMO Extracorporeal membrane oxygenation (ECMO) refers to mechanical support in patients for heart or lung function during cardiopulmonary failure. ECMO is used when conventional treatments have failed. As per the international guideline of the Extracorporeal Life Support Organization (ELSO), ECMO should be considered when the estimated mortality risk is about 50% and is mostly indicated when the mortality risk approac...