Antibiotic heterogeneity optimizes antimicrobial prescription and enables resistant pathogen control in the intensive care unit.
BACKGROUND
Multi-drug-resistant organisms (MDRO) complicate care increasingly on the general ward and in the emergency department, operating room, and intensive care unit (ICU). Whereas barrier precautions are important in limiting transmission of MDRO between patients, few tactics have been defined that reduce the genesis of MDRO.


METHODS
Review of pertinent English-language literature.


RESULTS
Antibiotic heterogeneity practices, as part of an overall antimicrobial drug stewardship program, offer one readily deployable means to reduce selection pressure for MDRO development in the ICU. The data underpinning this approach and data derived from its use indicate that, especially in surgical ICUs, heterogeneity of antibiotic prescribing can preserve or restore microbial ecology, reduce the prevalence of MDRO and the incidence of infections caused thereby, and facilitate the implementation and effectiveness of other antibiotic-sparing tactics, such as de-escalation.


CONCLUSIONS
Heterogeneity of antibiotic prescribing is effective in preventing the dissemination of MDRO pathogens.
Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Greta L
GL
Piper
Lewis J
LJ
Kaplan
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001419:Bacteria / Q000187:drug effects; D001424:Bacterial Infections / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D003428:Cross Infection / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units
D000900:Anti-Bacterial Agents