Review on strategies to minimize the appearance of multi-drug resistant organism

Background: The use of antibiotic drugs (ABX) in hospitals, and especially in intensive care units (ICU), is widespread. The early administration of ABX therapy can improve survival rates. The influence and impact of the ABX are observed in the patients who receive them (clinical response, course) and in the ecosystem surrounding the patient (hospital flora). Aim of the review: The objective of this review is to identify strategies that reduce or limit the appearance and transmission of multidrug-resistant microorganisms. This identification can then develop a rational use of the ABX plan in the ICU. Method: The following databases were queried; Medline, Embase, The Cochrane Library, and the Centre for Reviews and Dissemination (University of York), asking the questions in PICO format to evaluate the efficacy and safety of several interventions: A) Therapeutic de-escalation; B) Cycling of ABX and; C) Early antibiotic treatment. Results: A) In therapeutic de-escalation of 98 studies identified, three studies that met the inclusion criteria were analyzed. B) Two studies comparing antibiotic cycling versus other interventions were selected. C) No studies have been found with sufficiently robust methodological designs that address the ABX early treatment. There is no strong evidence to indicate which of the different antibiotic interventions (therapeutic de-escalation, cycling of ABX and preemptive treatment) is more effective in reducing antibiotic resistance in ICU patients. There is insufficient evidence that de-escalation of antimicrobial agents is effective against resistance. In patients admitted to the ICU with a low prevalence of fluoroquinolones resistance, increased exposure to this class of antibiotics, using antibiotic cycling, increases the emergence of resistant strains. Conclusion: Despite the fact that no prospective studies were identified in this SR, rationale and day-to-day clinical practice experience suggest that multidisciplinary participation of different specialists in ABX's Infection and Policy Commission (or the ABX Commission), or the Pharmacy and Therapeutics Committee, might improve the development and application of these strategies.