Prof. Jan De Waele is a surgery-trained intensivist with a specific interest in severe infections in critically ill patients and works at the surgical ICU of the Ghent University Hospital in Belgium. Clinical interests include antimicrobial resistance and antimicrobial stewardship in the ICU. His research activities currently focus on optimizing antibiotic therapy in severely ill infected patients to improve outcome and combat resistance development. He is active in several societies; he is currently chairing the Infection Section of the European Society of Intensive Care Medicine (ESICM) and president of the Belgian Society of Intensive Care Medicine.
Sepsis and septic shock are important problems in critical care medicine as they are frequent, challenging to treat, and associated with high morbidity and mortality rates. Key factors in sepsis therapy include fluid resuscitation, support of failing organs, administration of antibiotics and source control. Given the impact of early and broad-spectrum empirical therapy in several studies and the emphasis placed on this in international guidelines, there is a low threshold for initiating antibiotics in many patients with a suspected infection. This has led to the widespread use of antibiotics in sick patients, which is often unnecessary or inappropriate. In recent decades, the problem of antimicrobial resistance has increased significantly worldwide, and the World Economic Forum has identified antimicrobial resistance as one of the main threats to healthcare. Numerous initiatives have been launched to combat antimicrobial resistance, and decreasing the use of antibiotics is a priority, as this is clearly linked to the problem of antimicrobial resistance. One of the strategies that have been developed as a response to increasing rates of antimicrobial resistance is the implementation of antimicrobial stewardship programs in acute care hospitals. Antimicrobial stewardship attempts to reduce antibiotic exposure while improving outcomes and may intuitively contrast with current antibiotic prescription practices. The challenge for physicians is thus to correctly diagnose infection and improve outcomes while reducing antibiotic use. This can be done by adhering to local guidelines for empirical therapy, better risk for multidrug resistance assessment, optimized antibiotic dosing, and integration of rapid diagnostic techniques in the decision-making process. Watchful waiting, or withholding antibiotics until the infection is confirmed, is justified in non-severely ill patients in whom the clinical picture is not clear. In this lecture, Jan J. De Waele explains how different antimicrobial resistances are produced and how this problem can be improved by integrating antimicrobial stewardship strategies in clinical practice, upholding the best empirical antibiotic therapy while reducing antibiotic consumption.
Published
Jan 2019
Clinical Case Antimicrobial resistance is a major issue in global health . It is estimated that in the next 35 years about 3 hundred million people worldwide will die from resistance infections. Even though antimicrobial resistance is a complex issue , with many agents involved, such as environment, livestock, and agriculture, it is a medical problem . Many pathogens are involved but the main ones are the ESKAPE pathogens : Enterococci. Staphylococci. Klebsiella. Acinetobacter. Pseudomonas. Enterobacteriaceae. The major threat comes from gram negative infections , with Pseudomonas and Enterobacteriaceae with the most lethal ones in terms of numbers, and Klebsiella and Acinetobacter being the most lethal ones in terms of resistance. One of the main problems with antimicrobial resistance is that there is significant selection pressure due to antibiotic use in healthcare and agriculture , and that the mutations that cause bacterial resistance are very mobile. This is is fueled by poor hygiene , suboptimal dosing , lack of source control , and globalization (patients and tourist traveling from one country to another). Also, there is significant variability in prevalence between countries and even between different regions in the same country, with local ecology being the main factor in terms of resistance. The main concern with the rise of antimicrobial resistance is the significant impact on global health and economy that will follow if antibiotics stop being effective . As antibiotic resistance spreads, a vicious cycle begins in which broad spectrum empirical treatment is used due to resistant microorganisms. This will increase antibiotic resistance and as a consequence more inadequate empirical treatments will be used. Even though there are new antibiotics on the way, the problem is that none of them covers all the resistance patterns . As regards surgical site infection , antibiotic resistance will make its prevention harder , causing a failure of empirical antibiotic therapy and limiting the use of antimicrobial guidelines. Dr. Jan J. De Waele MD, PhD in the Department of Critical Care Medicine at Ghent University Hospital (Belgium) argues that an antibiotic stewardship program associated with the prevention of spread , proper use of antibiotics , hand hygiene , targeted screening and isolation are critical to control antibiotic resistance, and that surgeons must be involved in multidisciplinary teams monitoring antibiotic use and antibiotic resistance.
Published
Jan 2018
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