# Practical Lessons on Antimicrobial Therapy for Critically Ill Patients

## TL;DR

This review discusses strategies to reduce sepsis in intensive care, emphasizing infection control, antimicrobial stewardship, and new treatment approaches.

## Contribution

The paper provides practical insights into managing antimicrobial therapy for critically ill patients amid rising antibiotic resistance and complex clinical challenges.

## Key findings

- Antimicrobial stewardship and de-escalation are critical in combating bacterial resistance in intensive care.
- Infection control and prevention of equipment and patient colonization are essential to reduce sepsis incidence.
- Tailoring treatments to disease endotypes and exploring novel antimicrobial delivery systems are key future directions.

## Abstract

Sepsis stands as a formidable global health challenge, with persistently elevated mortality rates in recent decades. Each year, sepsis not only contributes to heightened morbidity but also imposes substantial healthcare costs on survivors. This narrative review aims to highlight the targeted measures that can be instituted to alleviate the incidence and impact of sepsis in intensive care. Here we discuss measures to reduce nosocomial infections and the prevention of equipment and patient colonisation by resilient pathogens. The overarching global crisis of bacterial resistance to newly developed antimicrobial agents intensifies the imperative for antimicrobial stewardship and de-escalation. This urgency has been accentuated in recent years, notably during the COVID-19 pandemic, as high-dose steroids and opportunistic infections presented escalating challenges. Ongoing research into airway colonisation’s role in influencing disease outcomes among critically ill patients underscores the importance of tailoring treatments to disease endotypes within heterogeneous populations, which are important lessons for intensivists in training. Looking ahead, the significance of novel antimicrobial delivery systems and drug monitoring is poised to increase. This narrative review delves into the multifaceted barriers and facilitators inherent in effectively treating critically ill patients vulnerable to nosocomial infections. The future trajectory of intensive care medicine hinges on the meticulous implementation of vigilant stewardship programs, robust infection control measures, and the continued exploration of innovative and efficient technological solutions within this demanding healthcare landscape.