Update in antibiotic therapy in intensive care unit: report from the 2019 Nîmes International Symposium - 24/10/19

Doi : 10.1016/j.accpm.2019.09.009

Marc Leone ^a,⁎ , Jason A. Roberts ^b,^c,^d, Matteo Bassetti ^e,^f, Adrien Bouglé ^g, Jean-Philippe Lavigne ^h, Matthieu Legrand ⁱ, Michael Neely ^j, José-Artur Paiva ^m, Didier Payen ^k, Jordi Rello ^l, Claire Roger ^n,^o, Fredrik Sjövall ^p,^q, Boris Jung ^r
^a Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service d’Anesthésie et de Réanimation, Marseille, France
^b University of Queensland Centre for Clinical Research, Faculty of Medicine & Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia
^c Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
^d Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
^e Infectious Diseases Division, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
^f Department of Health Sciences, University of Genoa, Genoa, Italy
^g Sorbonne Université, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire La Pitié-Salpêtrière, Département d’Anesthésie et de Réanimation, Paris, France
^h VBMI, Inserm, U1047, Université Montpellier, UFR de Médecine, and Department of Microbiology, University Hospital Nîmes, Nîmes, France
ⁱ Department of Anesthesia and Perioperative Care, University of California, San Francisco, United States, Inserm U942, INI-CRCT Network, Paris, France
^j Laboratory of Applied Pharmacokinetics and Bioinformatics, The Saban Research Institute, Children's Hospital Los Angeles, and Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, US
^k University Paris 7 Denis Diderot, Paris Sorbonne Cité, Paris, France
^l CIBERES, Instituto Salud Carlos III & Vall d’Hebron Institut of Research, Barcelona, Spain
^m Department of Intensive Care Medicine–Centro Hospitalar Universitário São João - Faculty of Medicine–University of Porto–Grupo de Infecção e Sepsis, Porto, Portugal
ⁿ Department of Anesthesiology and Intensive Care, Pain and Emergency medicine, Nîmes-Caremeau University Hospital, Place du Professeur Robert Debré, 30029 Nîmes cedex 9, France
^o Physiology Department. EA 2992, Faculty of Medicine, Montpellier-Nimes University, Nîmes, France
^p Department of Intensive and perioperative care, Skane University Hospital Malmö, Sweden
^q Mitochondrial Medicine Department for Clinical Sciences, Lund University, Sweden
^r Département de Médecine Intensive et Réanimation, Inserm U-1046/CNRS U-9234 (PhyMedExp), Hôpital Lapeyronie, Montpellier, France

^⁎Corresponding author at: Service d’anesthésie et de réanimation, hôpital Nord, Chemin des Bourrely Marseille, 13015, France.Service d’anesthésie et de réanimation, hôpital NordChemin des Bourrely Marseille13015France

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Abstract

The 2019 Nîmes International Symposium in Antibiotic Therapy Optimisation aimed at determining the best approaches of a number of the antibiotic management strategies for critically ill patients. Experts reviewed the latest literature relating to requirements for an optimal antibiotic stewardship program, risks of sub-therapeutic dosing of antibiotics in critically ill patients, persisting issues about efficiency of combination therapy and the value of de-escalation, new perspectives of pharmacokinetics, drug toxicities including collateral damages-associated with antibiotics, the place of nebulisation of antibiotics, management of patients receiving extracorporeal therapies and the place of new antibiotics. In this paper, each of these issues is discussed with key messages presented after a brief review of evidence.

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Keywords : Antibiotics, Sepsis, Stewardship, Dosing, De-escalation