Antibiotic stewardship in the ICU: time to shift into overdrive

Annals of Intensive Care

Table 1 Risk factors for potentially resistant pathogens responsible for ventilator-associated /healthcare-associated pneumonia

	Risk factors for MDR* pathogen	Risk factors for MRSA
North America (IDSA/ATS) guidelines [57]	Prior intravenous antibiotic use within 90 d Septic shock at time of VAP ARDS preceding VAP Current hospitalization ≥ 5 days Acute renal replacement therapy prior to VAP onset	Antibiotic treatment during the prior 90 days Treatment in a unit where the prevalence of MRSA among S. aureus isolates is not known or is > 20% Prior detection of MRSA by culture or non-culture screening
European and Latin American (ERS/ESICM/ESCMID/ALAT) guidelines [42]	Hospital settings with high rates (> 25%) of MDR pathogens Previous antibiotic use Recent prolonged hospital stay (> 5 days of hospitalization) Previous colonization with MDR pathogens	ICU where > 25% of the S. aureus respiratory isolates are MRSA

MDR multi-drug resistant, MRSA methicillin-resistant Staphylococcus aureus, ARDS acute respiratory distress syndrome, VAP ventilator-associated pneumonia, IDSA Infectious Disease Society of America, ATS American Thoracic Society, ERS European Respiratory Society, ESICM European Society of Intensive Care Medicine, ESCMID European Society of Clinical Microbiology and Infectious Diseases, ALAT Asociación Latinoamericana del Tórax, ICU intensive care unit
^*Multidrug resistant pathogen defined as a pathogen not susceptible to at least one agent from three or more classes of antibiotics