Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric)

Cédric Bretonnière, Marc Leone, Christophe Milési, Bernard Allaouchiche, Laurence Armand-Lefevre, Olivier Baldesi, Lila Bouadma, Dominique Decré, Samy Figueiredo, Rémy Gauzit, Benoît Guery, Nicolas Joram, Boris Jung, Sigismond Lasocki, Alain Lepape, Fabrice Lesage, Olivier Pajot, François Philippart, Bertrand Souweine, Pierre Tattevin, Jean-François Timsit, Renaud Vialet, Jean Ralph Zahar, Benoît Misset, Jean-Pierre Bedos

Emerging resistance to antibiotics shows no signs of decline. At the same time, few new antibacterials are being discovered. There is a worldwide recognition regarding the danger of this situation. The urgency of the situation and the conviction that practices should change led the Société de Réanimation de Langue Française (SRLF) and the Société Française d'Anesthésie et de Réanimation (SFAR) to set up a panel of experts from various disciplines. These experts met for the first time at the end of 2012 and have since met regularly to issue the following 67 recommendations, according to the rigorous GRADE methodology. Five fields were explored: i) the link between the resistance of bacteria and the use of antibiotics in intensive care; ii) which microbiological data and how to use them to reduce antibiotic consumption; iii) how should antibiotic therapy be chosen to limit consumption of antibiotics; iv) how can antibiotic administration be optimized; v) review and duration of antibiotic treatments. In each institution, the appropriation of these recommendations should arouse multidisciplinary discussions resulting in better knowledge of local epidemiology, rate of antibiotic use, and finally protocols for improving the stewardship of antibiotics. These efforts should contribute to limit the emergence of resistant bacteria.