Antimicrobial stewardship during extracorporeal membrane oxygenation: challenges and new perspectives - PubMed
5 hours ago
- #ECMO
- #antimicrobial stewardship
- #pharmacokinetics
- ECMO is vital for severe cardiac and respiratory failure but increases infection risks and complicates antimicrobial prescribing.
- ECMO circuits alter antimicrobial pharmacokinetics/pharmacodynamics, risking underdosing or toxicity.
- Critically ill ECMO patients face challenges like metabolic derangements and renal replacement therapy affecting antibiotic therapy.
- Prophylactic antibiotics' use is controversial due to limited infection prevention benefits and potential resistance promotion.
- Stewardship interventions include protocol-driven prophylaxis, therapeutic drug monitoring, and de-escalation of broad-spectrum agents.
- Interprofessional stewardship programs can reduce antimicrobial use and costs without harming patient outcomes.
- Non-pharmacologic measures like aseptic techniques and preventive bundles are crucial alongside antimicrobial strategies.
- Knowledge gaps remain on optimal dosing and stewardship frameworks for ECMO patients.