Can Stewardship be Applied in ICU Settings?

For anyone attending ID Week this year, attendees could see a concerted emphasis was made in studies to examine stewardship. At the conference, clinicians shared studies in demonstrating ways to optimize diagnostics and novel treatment strategies for better overall approaches and optimal outcomes.

Although in theory this would be excellent to apply in all areas of medicine, it can especially challenging when thinking about patients with severe illness in ICU settings.

For example, in those patients dealing with hospital-acquired bacterial pneumonia (HABP) and ventilator-acquired bacterial pneumonia (VABP) the clinical approach can often mean wide spectrum antibiotic coverage.

However, Christian Sandrock, MD, MPH, FCCP, division vice chief of Internal Medicine and director of Critical Care at UC Davis Medical Center is employing a novel strategy in how they present testing data to their clinical team. “We might test on a really broad panel for gram-negatives…but we will show—for lack of a better term—the lowest common result…we want that most narrow spectrum [of antibiotics] so we choose what we want to show our physicians,” Sandrock stated.

Another unique strategy they employ is PCR testing for Clostridioides difficile testing in at-risk and high risk patients. Sandrock says they are taking a preventative approach in trying to avoid patients getting C diff and further complications.

Contagion has its ongoing short series of video interviews to discuss these pathogens, and Sandrock sat down in a far-ranging interview to discuss how his institution is handling treatment, protocols on HABP/VABP, and his perspective on the therapy pipeline.

In this episode, Sandrock discusses how his institution is carrying out stewardship where possible.