Antibiotic Stewardship in the Intensive Care Unit. An Official American Thoracic Society Workshop Report in Collaboration with the AACN, CHEST, CDC, and SCCM

Richard G Wunderink, Arjun Srinivasan, Philip S Barie, Jean Chastre, Charles S Dela Cruz, Ivor S Douglas, Margaret Ecklund, Scott E Evans, Scott R Evans, Anthony T Gerlach, Lauri A Hicks, Michael Howell, Melissa L Hutchinson, Robert C Hyzy, Sandra L Kane-Gill, Erika D Lease, Mark L Metersky, Nancy Munro, Michael S Niederman, Marcos I Restrepo, Curtis N Sessler, Steven Q Simpson, Sandra M Swoboda, Christina Vazquez Guillamet, Grant W Waterer, Curtis H Weiss, Richard G Wunderink, Arjun Srinivasan, Philip S Barie, Jean Chastre, Charles S Dela Cruz, Ivor S Douglas, Margaret Ecklund, Scott E Evans, Scott R Evans, Anthony T Gerlach, Lauri A Hicks, Michael Howell, Melissa L Hutchinson, Robert C Hyzy, Sandra L Kane-Gill, Erika D Lease, Mark L Metersky, Nancy Munro, Michael S Niederman, Marcos I Restrepo, Curtis N Sessler, Steven Q Simpson, Sandra M Swoboda, Christina Vazquez Guillamet, Grant W Waterer, Curtis H Weiss

Abstract

Intensive care units (ICUs) are an appropriate focus of antibiotic stewardship program efforts because a large proportion of any hospital's use of parenteral antibiotics, especially broad-spectrum, occurs in the ICU. Given the importance of antibiotic stewardship for critically ill patients and the importance of critical care practitioners as the front line for antibiotic stewardship, a workshop was convened to specifically address barriers to antibiotic stewardship in the ICU and discuss tactics to overcome these. The working definition of antibiotic stewardship is "the right drug at the right time and the right dose for the right bug for the right duration." A major emphasis was that antibiotic stewardship should be a core competency of critical care clinicians. Fear of pathogens that are not covered by empirical antibiotics is a major driver of excessively broad-spectrum therapy in critically ill patients. Better diagnostics and outcome data can address this fear and expand efforts to narrow or shorten therapy. Greater awareness of the substantial adverse effects of antibiotics should be emphasized and is an important counterargument to broad-spectrum therapy in individual low-risk patients. Optimal antibiotic stewardship should not focus solely on reducing antibiotic use or ensuring compliance with guidelines. Instead, it should enhance care both for individual patients (by improving and individualizing their choice of antibiotic) and for the ICU population as a whole. Opportunities for antibiotic stewardship in common ICU infections, including community- and hospital-acquired pneumonia and sepsis, are discussed. Intensivists can partner with antibiotic stewardship programs to address barriers and improve patient care.

Keywords: antibiotic resistance; antibiotic stewardship; pneumonia; sepsis.

References

    1. The President’s Council of Advisors on Science and Technology. Report to the President on combating antibiotic resistance. September 2014 [accessed 2020 Apr 12]. Available from: .
    1. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323–2329.
    1. Tabah A, Koulenti D, Laupland K, Misset B, Valles J, Bruzzi de Carvalho F, et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med. 2012;38:1930–1945.
    1. Steinberg M, Dresser LD, Daneman N, Smith OM, Matte A, Marinoff N, et al. A national survey of critical care physicians’ knowledge, attitudes, and perceptions of antimicrobial stewardship programs. J Intensive Care Med. 2016;31:61–65.
    1. Kollef MH, Micek ST. Antimicrobial stewardship programs: mandatory for all ICUs. Crit Care. 2012;16:179.
    1. Decker B, Masur H. Bad bugs, no drugs: are we part of the problem, or leaders in developing solutions? Crit Care Med. 2015;43:1153–1155.
    1. IDSA Sepsis Task Force. Infectious Diseases Society of America (IDSA) position statement: why IDSA did not endorse the Surviving Sepsis Campaign guidelines. Clin Infect Dis. 2018;66:1631–1635.
    1. Broom J, Broom A. Guideline relevance, diagnostic uncertainty, fear and hierarchy: intersecting barriers to antibiotic optimization in respiratory infections. Respirology. 2018;23:733–734.
    1. Charani E, Castro-Sanchez E, Sevdalis N, Kyratsis Y, Drumright L, Shah N, et al. Understanding the determinants of antimicrobial prescribing within hospitals: the role of “prescribing etiquette”. Clin Infect Dis. 2013;57:188–196.
    1. Society for Healthcare Epidemiology of America; Infectious Diseases Society of America; Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) Infect Control Hosp Epidemiol. 2012;33:322–327.
    1. Kadri SS. Recognizing the unique role of critical care providers in confronting antimicrobial resistance. Am J Respir Crit Care Med. 2018;198:560–562.
    1. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. EPIC International Advisory Committee. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) study. JAMA. 1995;274:639–644.
    1. Orsini J, Mainardi C, Muzylo E, Karki N, Cohen N, Sakoulas G. Microbiological profile of organisms causing bloodstream infection in critically ill patients. J Clin Med Res. 2012;4:371–377.
    1. Adrie C, Garrouste-Orgeas M, Ibn Essaied W, Schwebel C, Darmon M, Mourvillier B, et al. OUTCOMEREA Study Group*. Attributable mortality of ICU-acquired bloodstream infections: impact of the source, causative micro-organism, resistance profile and antimicrobial therapy. J Infect. 2017;74:131–141.
    1. McKenzie MS, Auriemma CL, Olenik J, Cooney E, Gabler NB, Halpern SD. An observational study of decision making by medical intensivists. Crit Care Med. 2015;43:1660–1668.
    1. Vardakas KZ, Voulgaris GL, Maliaros A, Samonis G, Falagas ME. Prolonged versus short-term intravenous infusion of antipseudomonal β-lactams for patients with sepsis: a systematic review and meta-analysis of randomised trials. Lancet Infect Dis. 2018;18:108–120.
    1. Weiss CH, Moazed F, McEvoy CA, Singer BD, Szleifer I, Amaral LA, et al. Prompting physicians to address a daily checklist and process of care and clinical outcomes: a single-site study. Am J Respir Crit Care Med. 2011;184:680–686.
    1. Fleming D, Ali KF, Matelski J, D’Sa R, Powis J. When antimicrobial stewardship isn’t watching: the educational impact of critical care prospective audit and feedback. Open Forum Infect Dis. 2016;3:ofw115.
    1. Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, et al. Cooperative Antimicrobial Therapy of Septic Shock Database Research Group. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136:1237–1248.
    1. Broom J, Broom A, Plage S, Adams K, Post JJ. Barriers to uptake of antimicrobial advice in a UK hospital: a qualitative study. J Hosp Infect. 2016;93:418–422.
    1. Braykov NP, Morgan DJ, Schweizer ML, Uslan DZ, Kelesidis T, Weisenberg SA, et al. Assessment of empirical antibiotic therapy optimisation in six hospitals: an observational cohort study. Lancet Infect Dis. 2014;14:1220–1227.
    1. Bergmans DC, Bonten MJ, Gaillard CA, van Tiel FH, van der Geest S, de Leeuw PW, et al. Indications for antibiotic use in ICU patients: a one-year prospective surveillance. J Antimicrob Chemother. 1997;39:527–535.
    1. Micek ST, Lang A, Fuller BM, Hampton NB, Kollef MH. Clinical implications for patients treated inappropriately for community-acquired pneumonia in the emergency department. BMC Infect Dis. 2014;14:61.
    1. Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2017;2:CD003543.
    1. Dyar OJ, Obua C, Chandy S, Xiao Y, Stålsby Lundborg C, Pulcini C. Using antibiotics responsibly: are we there yet? Future Microbiol. 2016;11:1057–1071.
    1. Paonessa JR, Shah RD, Pickens CI, Lizza BD, Donnelly HK, Malczynski M, et al. Rapid detection of methicillin-resistant Staphylococcus aureus in BAL: a pilot randomized controlled trial. Chest. 2019;155:999–1007.
    1. Micek ST, Ward S, Fraser VJ, Kollef MH. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest. 2004;125:1791–1799.
    1. Bekaert M, Timsit JF, Vansteelandt S, Depuydt P, Vésin A, Garrouste-Orgeas M, et al. Outcomerea Study Group. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med. 2011;184:1133–1139.
    1. Kim JH, Gallis HA. Observations on spiraling empiricism: its causes, allure, and perils, with particular reference to antibiotic therapy. Am J Med. 1989;87:201–206.
    1. Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med. 2017;177:1308–1315.
    1. Hranjec T, Rosenberger LH, Swenson B, Metzger R, Flohr TR, Politano AD, et al. Aggressive versus conservative initiation of antimicrobial treatment in critically ill surgical patients with suspected intensive-care-unit-acquired infection: a quasi-experimental, before and after observational cohort study. Lancet Infect Dis. 2012;12:774–780.
    1. Karanika S, Paudel S, Zervou FN, Grigoras C, Zacharioudakis IM, Mylonakis E. Prevalence and clinical outcomes of Clostridium difficile infection in the intensive care unit: a systematic review and meta-analysis. Open Forum Infect Dis. 2015;3:ofv186.
    1. Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, et al. PneumA Trial Group. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290:2588–2598.
    1. Raman K, Nailor MD, Nicolau DP, Aslanzadeh J, Nadeau M, Kuti JL. Early antibiotic discontinuation in patients with clinically suspected ventilator-associated pneumonia and negative quantitative bronchoscopy cultures. Crit Care Med. 2013;41:1656–1663.
    1. Baggs J, Jernigan JA, Halpin AL, Epstein L, Hatfield KM, McDonald LC. Risk of subsequent sepsis within 90 days after a hospital stay by type of antibiotic exposure. Clin Infect Dis. 2018;66:1004–1012.
    1. Luther MK, Timbrook TT, Caffrey AR, Dosa D, Lodise TP, LaPlante KL. Vancomycin plus piperacillin-tazobactam and acute kidney injury in adults: a systematic review and meta-analysis. Crit Care Med. 2018;46:12–20.
    1. Schreier DJ, Kashani KB, Sakhuja A, Mara KC, Tootooni MS, Personett HA, et al. Incidence of acute kidney injury among critically ill patients with brief empiric use of antipseudomonal β-lactams with vancomycin. Clin Infect Dis. 2019;68:1456–1462.
    1. Kett DH, Cano E, Quartin AA, Mangino JE, Zervos MJ, Peyrani P, et al. Improving Medicine through Pathway Assessment of Critical Therapy of Hospital-Acquired Pneumonia (IMPACT-HAP) Investigators. Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study. Lancet Infect Dis. 2011;11:181–189.
    1. Dean NC, Bateman KA, Donnelly SM, Silver MP, Snow GL, Hale D. Improved clinical outcomes with utilization of a community-acquired pneumonia guideline. Chest. 2006;130:794–799.
    1. McCabe C, Kirchner C, Zhang H, Daley J, Fisman DN. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Arch Intern Med. 2009;169:1525–1531.
    1. Frei CR, Attridge RT, Mortensen EM, Restrepo MI, Yu Y, Oramasionwu CU, et al. Guideline-concordant antibiotic use and survival among patients with community-acquired pneumonia admitted to the intensive care unit. Clin Ther. 2010;32:293–299.
    1. Go ES, Urban C, Burns J, Kreiswirth B, Eisner W, Mariano N, et al. Clinical and molecular epidemiology of acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet. 1994;344:1329–1332.
    1. Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother. 2011;66:1223–1230.
    1. Gillespie D, Francis NA, Carrol ED, Thomas-Jones E, Butler CC, Hood K. Use of co-primary outcomes for trials of antimicrobial stewardship interventions. Lancet Infect Dis. 2018;18:595–597.
    1. Banerjee R, Teng CB, Cunningham SA, Ihde SM, Steckelberg JM, Moriarty JP, et al. Randomized trial of rapid multiplex polymerase chain reaction-based blood culture identification and susceptibility testing. Clin Infect Dis. 2015;61:1071–1080.
    1. Sanchez-Nieto JM, Torres A, Garcia-Cordoba F, El-Ebiary M, Carrillo A, Ruiz J, et al. Impact of invasive and noninvasive quantitative culture sampling on outcome of ventilator-associated pneumonia: a pilot study. Am J Respir Crit Care Med. 1998;157:371–376.
    1. Huang DT, Yealy DM, Filbin MR, Brown AM, Chang CH, Doi Y, et al. ProACT Investigators. Procalcitonin-guided use of antibiotics for lower respiratory tract infection. N Engl J Med. 2018;379:236–249.
    1. Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006;355:2619–2630.
    1. Trevino SE, Pence MA, Marschall J, Kollef MH, Babcock HM, Burnham CD. Rapid MRSA PCR on respiratory specimens from ventilated patients with suspected pneumonia: a tool to facilitate antimicrobial stewardship. Eur J Clin Microbiol Infect Dis. 2017;36:879–885.
    1. He Q, Chen W, Huang L, Lin Q, Zhang J, Liu R, et al. Performance evaluation of three automated identification systems in detecting carbapenem-resistant Enterobacteriaceae. Ann Clin Microbiol Antimicrob. 2016;15:40.
    1. de Jong E, van Oers JA, Beishuizen A, Vos P, Vermeijden WJ, Haas LE, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis. 2016;16:819–827.
    1. Christ-Crain M, Stolz D, Bingisser R, Müller C, Miedinger D, Huber PR, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006;174:84–93.
    1. Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. PRORATA trial group. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010;375:463–474.
    1. Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med. 2008;177:498–505.
    1. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61–e111.
    1. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27–S72.
    1. Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT) Eur Respir J. 2017;50:1700582.
    1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–377.
    1. Vanderkooi OG, Low DE, Green K, Powis JE, McGeer A Toronto Invasive Bacterial Disease Network. Predicting antimicrobial resistance in invasive pneumococcal infections. Clin Infect Dis. 2005;40:1288–1297.
    1. Hobbs AL, Shea KM, Roberts KM, Daley MJ. Implications of augmented renal clearance on drug dosing in critically ill patients: a focus on antibiotics. Pharmacotherapy. 2015;35:1063–1075.
    1. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.
    1. Shindo Y, Ito R, Kobayashi D, Ando M, Ichikawa M, Shiraki A, et al. Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2013;188:985–995.
    1. Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373:415–427.
    1. Aliberti S, Reyes LF, Faverio P, Sotgiu G, Dore S, Rodriguez AH, et al. GLIMP investigators. Global Initiative for Meticillin-resistant Staphylococcus aureus Pneumonia (GLIMP): an international, observational cohort study. Lancet Infect Dis. 2016;16:1364–1376.
    1. Restrepo MI, Babu BL, Reyes LF, Chalmers JD, Soni NJ, Sibila O, et al. GLIMP. Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia: a multinational point prevalence study of hospitalised patients. Eur Respir J. 2018;52:1701190.
    1. Attridge RT, Frei CR, Restrepo MI, Lawson KA, Ryan L, Pugh MJ, et al. Guideline-concordant therapy and outcomes in healthcare-associated pneumonia. Eur Respir J. 2011;38:878–887.
    1. Haas MK, Dalton K, Knepper BC, Stella SA, Cervantes L, Price CS, et al. Effects of a syndrome-specific antibiotic stewardship intervention for inpatient community-acquired pneumonia. Open Forum Infect Dis. 2016;3:ofw186.
    1. Dean NC, Jones BE, Jones JP, Ferraro JP, Post HB, Aronsky D, et al. Impact of an electronic clinical decision support tool for emergency department patients with pneumonia. Ann Emerg Med. 2015;66:511–520.
    1. Jones BE, Brown KA, Jones MM, Huttner BD, Greene T, Sauer BC, et al. Variation in empiric coverage versus detection of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in hospitalizations for community-onset pneumonia across 128 US Veterans Affairs medical centers. Infect Control Hosp Epidemiol. 2017;38:937–944.
    1. Berger A, Edelsberg J, Oster G, Huang X, Weber DJ. Patterns of initial antibiotic therapy for community-acquired pneumonia in U.S. hospitals, 2000 to 2009. Am J Med Sci. 2014;347:347–356.
    1. Richter SS, Diekema DJ, Heilmann KP, Dohrn CL, Riahi F, Doern GV. Changes in pneumococcal serotypes and antimicrobial resistance after introduction of the 13-valent conjugate vaccine in the United States. Antimicrob Agents Chemother. 2014;58:6484–6489.
    1. Prina E, Ranzani OT, Polverino E, Cilloniz C, Ferrer M, Fernandez L, et al. Risk factors associated with potentially antibiotic resistant pathogens in community-acquired pneumonia. Ann Am Thorac Soc. 2015;12:153–160.
    1. von Baum H, Welte T, Marre R, Suttorp N, Ewig S CAPNETZ study group. Community-acquired pneumonia through Enterobacteriaceae and Pseudomonas aeruginosa: diagnosis, incidence and predictors. Eur Respir J. 2010;35:598–605.
    1. Gillet Y, Vanhems P, Lina G, Bes M, Vandenesch F, Floret D, et al. Factors predicting mortality in necrotizing community-acquired pneumonia caused by Staphylococcus aureus containing Panton-Valentine leukocidin. Clin Infect Dis. 2007;45:315–321.
    1. Lobo LJ, Reed KD, Wunderink RG. Expanded clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus pneumonia. Chest. 2010;138:130–136.
    1. Griffin AT, Peyrani P, Wiemken TL, Ramirez JA, Arnold FW. Empiric therapy directed against MRSA in patients admitted to the intensive care unit does not improve outcomes in community-acquired pneumonia. Infection. 2013;41:517–523.
    1. van der Eerden MM, Vlaspolder F, de Graaff CS, Groot T, Bronsveld W, Jansen HM, et al. Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study. Thorax. 2005;60:672–678.
    1. Self WH, Grijalva CG, Williams DJ, Woodworth A, Balk RA, Fakhran S, et al. Procalcitonin as an early marker of the need for invasive respiratory or vasopressor support in adults with community-acquired pneumonia. Chest. 2016;150:819–828.
    1. Rothberg MB, Zilberberg MD, Pekow PS, Priya A, Haessler S, Belforti R, et al. Association of guideline-based antimicrobial therapy and outcomes in healthcare-associated pneumonia. J Antimicrob Chemother. 2015;70:1573–1579.
    1. Soo Hoo GW, Wen YE, Nguyen TV, Goetz MB. Impact of clinical guidelines in the management of severe hospital-acquired pneumonia. Chest. 2005;128:2778–2787.
    1. Ioannidis JP, Lau J. State of the evidence: current status and prospects of meta-analysis in infectious diseases. Clin Infect Dis. 1999;29:1178–1185.
    1. Kollef MH, Kollef KE. Antibiotic utilization and outcomes for patients with clinically suspected ventilator-associated pneumonia and negative quantitative BAL culture results. Chest. 2005;128:2706–2713.
    1. Cowley MC, Ritchie DJ, Hampton N, Kollef MH, Micek ST. Outcomes associated with de-escalating therapy for methicillin-resistant Staphylococcus aureus in culture-negative nosocomial pneumonia. Chest. 2019;155:53–59.
    1. Fagon JY, Chastre J, Wolff M, Gervais C, Parer-Aubas S, Stéphan F, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Ann Intern Med. 2000;132:621–630.
    1. Meduri GU, Mauldin GL, Wunderink RG, Leeper KV, Jr, Jones CB, Tolley E, et al. Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia. Chest. 1994;106:221–235.
    1. Pulido MR, Moreno-Martinez P, Gonzalez-Galan V, Fernandez Cuenca F, Pascual A, Garnacho-Montero J, et al. MagicBullet Working Group. Application of BioFire FilmArray blood culture identification panel for rapid identification of the causative agents of ventilator-associated pneumonia. Clin Microbiol Infect. 2018;24:1213.e1–1213.e4.
    1. Weiss E, Zahar JR, Garrouste-Orgeas M, Ruckly S, Essaied W, Schwebel C, et al. OUTCOMEREA Study Group. De-escalation of pivotal beta-lactam in ventilator-associated pneumonia does not impact outcome and marginally affects MDR acquisition. Intensive Care Med. 2016;42:2098–2100.
    1. Kollef MH, Chastre J, Clavel M, Restrepo MI, Michiels B, Kaniga K, et al. A randomized trial of 7-day doripenem versus 10-day imipenem-cilastatin for ventilator-associated pneumonia. Crit Care. 2012;16:R218.
    1. Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: A cohort study. J Allergy Clin Immunol. 2014;133:790–796.
    1. Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and management of penicillin allergy: a review. JAMA. 2019;321:188–199.
    1. Plataki M, Kashani K, Cabello-Garza J, Maldonado F, Kashyap R, Kor DJ, et al. Predictors of acute kidney injury in septic shock patients: an observational cohort study. Clin J Am Soc Nephrol. 2011;6:1744–1751.
    1. Ferrer R, Martin-Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med. 2014;42:1749–1755.
    1. Iscimen R, Cartin-Ceba R, Yilmaz M, Khan H, Hubmayr RD, Afessa B, et al. Risk factors for the development of acute lung injury in patients with septic shock: an observational cohort study. Crit Care Med. 2008;36:1518–1522.
    1. Kojicic M, Li G, Hanson AC, Lee KM, Thakur L, Vedre J, et al. Risk factors for the development of acute lung injury in patients with infectious pneumonia. Crit Care. 2012;16:R46.
    1. Whiles BB, Deis AS, Simpson SQ. Increased time to initial antimicrobial administration is associated with progression to septic shock in severe sepsis patients. Crit Care Med. 2017;45:623–629.
    1. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34:1589–1596.
    1. Liu VX, Fielding-Singh V, Greene JD, Baker JM, Iwashyna TJ, Bhattacharya J, et al. The timing of early antibiotics and hospital mortality in sepsis. Am J Respir Crit Care Med. 2017;196:856–863.
    1. Montravers P, Tubach F, Lescot T, Veber B, Esposito-Farèse M, Seguin P, et al. DURAPOP Trial Group. Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial. Intensive Care Med. 2018;44:300–310.
    1. Klein Klouwenberg PM, Cremer OL, van Vught LA, Ong DS, Frencken JF, Schultz MJ, et al. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study. Crit Care. 2015;19:319.

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