Table 2.

Summary of Key Elements of an Antibiotic Stewardship Program in the ICU

Key Elements of ASP in ICU	Summary	Outcomes
Leadership	Collaboration between critical care physician, ID pharmacist, and hospital’s ASP33	Not applicable
Prospective audit and feedback	Review of broad-spectrum antibiotics on day 3 and deescalate when appropriate	Decrease in days of broad-spectrum antibiotics36 Reduced rate of CDI37 Decreased hospital LOS37
Antibiotic time-out	Physician/trainee-led approach to review antibiotic indications on a biweekly basis and monthly teaching sessions for trainees	Decreased use of fluoroquinolones38 Some cost savings38
Rapid diagnostics and laboratory testing	Viral multiplex PCR platform Rapid PCR for MRSA Serial procalcitonin	Decreased hospital LOS, ICU admission rates39 Decreased use of empiric vancomycin40 Shorter duration of antibiotics39, 40
Clinical pathways	Guide that asks physicians to enter signs/symptoms and provides recommendations for antibiotics Beneficial in diagnoses when treatment guidelines are well established	Decreased length of ICU stay for patients with CAP41, 42
Computerized decision support	Electronic decision support that uses antibiograms and patient data to generate antibiotic recommendations	Decreased antibiotic use43 Cost savings43 No negative impact on mortality43, 44
Infection control	Preventive strategies such as handwashing, contact/droplet precautions	Decreased rates of nosocomial infection45

ASP = antibiotic stewardship program; CAP = community-acquired pneumonia; CDC = Centers for Disease Control and Prevention; ID = infectious diseases; MRSA = methicillin-resistant Staphylococcus aureus; PCR = polymerase chain reaction. See Table 1 legend for expansion of other abbreviations.