Management of antibiotic resistance in the intensive care unit setting.
Over the past few decades, an alarming increase of infections caused by antibiotic-resistant pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus species, carbapenem-resistant Pseudomonas aeruginosa, extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp., and multidrug-resistant Acinetobacter spp., has been observed, particularly in intensive care units. For clinicians, the rising resistance rate observed in nosocomial pathogens, when coupled with the lack of effective antimicrobials, represents the real challenge in the therapeutic management of critically ill patients. The contribution of clinicians in minimizing the increasing trend of resistance is represented by reduction of the patients' exposure to antibiotics, which reduces the resistance-selecting pressure, and by avoiding unnecessary antibiotic treatments. Recent issues on strategies to minimize resistance development and to appropriately manage critically ill patients with infections caused by multidrug-resistant organisms in the intensive care unit setting are discussed in this article.
Petrosillo
Nicola
N
2nd Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, Via Portuense, 292-00149 Rome, Italy. nicola.petrosillo@inmi.it
Capone
Alessandro
A
Di Bella
Stefano
S
Taglietti
Fabrizio
F
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D004352:Drug Resistance, Microbial / Q000187:drug effects*; D004359:Drug Therapy, Combination; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D006095:Gram-Positive Cocci / Q000187:drug effects*; D006801:Humans; D007362:Intensive Care Units; D008826:Microbial Sensitivity Tests
D000900:Anti-Bacterial Agents