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Semin Respir Crit Care Med 2022; 43(01): 141-149
DOI: 10.1055/s-0041-1741014
Review Article

Antibiotic Decision-Making in the ICU

Luis Parra-Rodriguez
1   Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
,
M. Cristina Vazquez Guillamet
1   Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
2   Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Abstract

It is well established that Intensive Care Units (ICUs) are a focal point in antimicrobial consumption with a major influence on the ecological consequences of antibiotic use. With the high prevalence and mortality of infections in critically ill patients, and the clinical challenges of treating patients with septic shock, the impact of real life clinical decisions made by intensivists becomes more significant. Both under- and over-treatment with unnecessarily broad spectrum antibiotics can lead to detrimental outcomes. Even though substantial progress has been made in developing rapid diagnostic tests that can help guide antibiotic use, there is still a time window when clinicians must decide the empiric antibiotic treatment with insufficient clinical data. The continuous streams of data available in the ICU environment make antimicrobial optimization an ongoing challenge for clinicians but at the same time can serve as the input for sophisticated models. In this review, we summarize the evidence to help guide antibiotic decision-making in the ICU. We focus on 1) deciding if to start antibiotics, 2) choosing the spectrum of the empiric agents to use, and 3) de-escalating the chosen empiric antibiotics. We provide a perspective on the role of machine learning and artificial intelligence models for clinical decision support systems that can be incorporated seamlessly into clinical practice in order to improve the antibiotic selection process and, more importantly, current and future patients' outcomes.

Keywords

empiric antibiotics - antimicrobial resistance - clinical decision support systems - machine learning / artificial intelligence


Publication History

Article published online:
16 February 2022

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