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AMS in the ICU: empiric therapy and adherence to guidelines for pneumonia
  1. Shelby Pflanzner1,
  2. Casey Phillips2,
  3. Jonathan Mailman1,3,
  4. Jason Robert Vanstone4
  1. 1Department of Pharmacy Services, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
  2. 2Antimicrobial Stewardship Program, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
  3. 3College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  4. 4Stewardship and Clinical Appropriateness, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
  1. Correspondence to Dr Jason Robert Vanstone; jason.vanstone{at}saskhealthauthority.ca

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Introduction

Antimicrobial stewardship (AMS) aims to preserve the efficacy of antimicrobials by selecting the right drug, dose and duration for the appropriate indication, resulting in maximum benefit and minimising adverse events and development of antimicrobial resistance.1 2 While AMS interventions may appear to be at odds with practice in the intensive care unit (ICU), they can improve quality of care without compromising patient outcomes.2 This study assessed if empiric antimicrobial therapy aligned with guideline recommendations for critically ill patients with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP) or aspiration pneumonia.

Methods

This retrospective chart review included patients discharged or expired from three mixed medical/surgical ICUs in Regina, Saskatchewan, Canada between October 2016 and March 2017. Patients were included if they were ≥18 years old and had ICD-10 codes corresponding to pneumonia and an indication for pneumonia recorded in their chart; they were excluded if they were not in the ICU while being treated for pneumonia or for any subsequent ICU re-admissions (ie, index admission only). Records were assessed for antimicrobial alignment with guideline recommendations for each type of pneumonia.3–5 If the regimen was not guideline concordant, further assessment by two clinical experts was conducted to determine if it was still clinically appropriate by taking into consideration local antibiogram patterns and other available patient-specific factors, such as allergies, recent antimicrobial exposure, suspected co-infections and concomitant disease states. This study …

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