Bugs, hosts and ICU environment: countering pan-resistance in nosocomial microbiota and treating bacterial infections in the critical care setting.
ICUs are areas where resistance problems are the largest, and these constitute 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, metallo-betalactamases) 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 led to multidrug resistance, a worrisome problem nowadays. This article reviews 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.
Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain. Electronic address: emilio.maseda@gmail.com.
Emilio
E
Maseda
Infectious Diseases Department, Hospital Clínic, Barcelona, Spain.
José
J
Mensa
Anesthesiology and Surgical Critical Care Department, Hospital General Universitario, Valencia, Spain.
Juan-Carlos
JC
Valía
Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario, Valladolid, Spain.
José-Ignacio
JI
Gomez-Herreras
Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Princesa, Madrid, Spain.
Fernando
F
Ramasco
Anesthesiology and Surgical Critical Care Department, Hospital del Mar, Barcelona, Spain.
Enric
E
Samso
Anesthesiology and Surgical Critical Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Miguel-Angel
MA
Chiveli
Anesthesiology and Surgical Critical Care Department, Complejo Hospitalario de Vigo, Vigo, Spain.
Jorge
J
Pereira
Anesthesiology and Surgical Critical Care Department, Hospital de León, León, Spain.
Rafael
R
González
Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario, Valencia, Spain.
Gerardo
G
Aguilar
Anesthesiology and Surgical Critical Care Department, Hospital de Cruces, Bilbao, Spain.
Gonzalo
G
Tamayo
Anesthesiology and Surgical Critical Care Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
Nazario
N
Ojeda
Anesthesiology and Surgical Critical Care Department, Hospital Universitario Río Hortega, Valladolid, Spain.
Jesús
J
Rico
PRISM-AG, Madrid, Spain.
María-José
MJ
Giménez
PRISM-AG, Madrid, Spain.
Lorenzo
L
Aguilar
D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D004197:Disease Reservoirs; D004352:Drug Resistance, Microbial; D054884:Host-Pathogen Interactions; D006801:Humans; D007362:Intensive Care Units; D064307:Microbiota; D010641:Phenotype; D012307:Risk Factors; D013045:Species Specificity; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control
D000900:Anti-Bacterial Agents
Acinetobacter baumannii; Betalactamasas de espectro prolongado; Critical care; Cuidados críticos; Enterococo resistente a vancomicina; Extended spectrum β-lactamase; Methicillin-resistant Staphylococcus aureus; Pseudomonas aeruginosa; Staphycoccus aureus resistente a meticilina; Vancomycin-resistant enterococci