title: Effectiveness of programs to decrease antimicrobial resistance in the intensive care unit.
abstract: Resistance of microbes to antibiotics is an increasing problem in intensive care units (ICUs) with a prevalence of 86% in some isolates. Resistance results in increased morbidity, mortality, and increased costs. Risk factors associated with the development of resistance and strategies to combat resistance are discussed. Risk factors include increased antibiotic use, host factors including severity of illness and length of stay, and lack of adherence to infection control practices. Multiple strategies to decrease resistance have been studied. Changing antimicrobial practices via guideline development, antibiotic restriction, use of information systems technology, crop rotation, narrowing spectrum of empiric antibiotics, multidisciplinary approaches, and selective decontamination have had variable results. Prevention of horizontal transmission via handwashing, glove and gown use, alternatives to soap, and improving the workload and facilities for health care workers is discussed. Primary prevention via decreased length of stay, selective digestive decontamination, vaccine development, and decreased use of invasive devices also plays a role.
authors.affiliation: Center for Pulmonary and Critical Care Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA.
authors.forename: Charles Scott
authors.initials: CS
authors.lastname: Hall
authors.forename: David E
authors.initials: DE
authors.lastname: Ost
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods / Q000458:organization & administration*; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D011322:Primary Prevention / Q000458:organization & administration; D011379:Prognosis; D016730:Program Development; D015397:Program Evaluation; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents