title: Bugs, hosts and ICU environment: countering pan-resistance in nosocomial microbiota and treating bacterial infections in the critical care setting.
abstract: ICUs are areas where resistance problems are the largest, and they constitutes a major problem for the intensivist's clinical practice. Main resistance phenotypes among nosocomial microbiota are: i) vancomycin-resistance/heteroresistance and tolerance in grampositives (MRSA, enterococci) and ii) efflux pumps/enzymatic resistance mechanisms (ESBLs, AmpC, metallobetalactamases) in gramnegatives. These phenotypes are found at different rates in pathogens causing respiratory (nosocomial pneumonia/ventilator-associated pneumonia), bloodstream (primary bacteremia/catheter-associated bacteremia), urinary, intraabdominal and surgical wound infections and endocarditis in the ICU. New antibiotics are available to overcome non-susceptibility in grampositives; however, accumulation of resistance traits in gramnegatives has lead to multidrug resistance, a worrisome problem nowadays. This article reviews by microorganism/infection risk factors for multidrug resistance, suggesting adequate empirical treatments. Drugs, patient and environmental factors all play a role in the decision to prescribe/recommend antibiotic regimens in the specific ICU patient, implying that intensivists should be familiar with available drugs, environmental epidemiology and patient factors.
authors.affiliation: Emilio Maseda, Anesthesiology and Surgical Critical Care Dpt., Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. emilio.maseda@gmail.com.
authors.forename: Emilio
authors.initials: E
authors.lastname: Maseda
authors.forename: José
authors.initials: J
authors.lastname: Mensa
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Valía
authors.forename: Jose-Ignacio
authors.initials: JI
authors.lastname: Gomez-Herreras
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramasco
authors.forename: Enric
authors.initials: E
authors.lastname: Samso
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Chiveli
authors.forename: Jorge
authors.initials: J
authors.lastname: Pereira
authors.forename: Rafael
authors.initials: R
authors.lastname: González
authors.forename: Gerardo
authors.initials: G
authors.lastname: Aguilar
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Tamayo
authors.forename: Nazario
authors.initials: N
authors.lastname: Ojeda
authors.forename: Jesús
authors.initials: J
authors.lastname: Rico
authors.forename: María José
authors.initials: MJ
authors.lastname: Gimenez
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Aguilar
mesh_terms: D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D003422:Critical Care / Q000379:methods*; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D004203:Disinfection; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects; D006801:Humans; D007362:Intensive Care Units; D055624:Methicillin-Resistant Staphylococcus aureus; D064307:Microbiota; D013530:Surgical Wound Infection / Q000188:drug therapy; D020713:Vancomycin Resistance; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases