title: Preventive and therapeutic strategies in critically ill patients with highly resistant bacteria.
abstract: The antibiotic pipeline continues to diminish and the majority of the public remains unaware of this critical situation. The cause of the decline of antibiotic development is multifactorial and currently most ICUs are confronted with the challenge of multidrug-resistant organisms. Antimicrobial multidrug resistance is expanding all over the world, with extreme and pandrug resistance being increasingly encountered, especially in healthcare-associated infections in large highly specialized hospitals. Antibiotic stewardship for critically ill patients translated into the implementation of specific guidelines, largely promoted by the Surviving Sepsis Campaign, targeted at education to optimize choice, dosage, and duration of antibiotics in order to improve outcomes and reduce the development of resistance. Inappropriate antimicrobial therapy, meaning the selection of an antibiotic to which the causative pathogen is resistant, is a consistent predictor of poor outcomes in septic patients. Therefore, pharmacokinetically/pharmacodynamically optimized dosing regimens should be given to all patients empirically and, once the pathogen and susceptibility are known, local stewardship practices may be employed on the basis of clinical response to redefine an appropriate regimen for the patient. This review will focus on the most severely ill patients, for whom substantial progress in organ support along with diagnostic and therapeutic strategies markedly increased the risk of nosocomial infections.
authors: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy, mattba@tin.it.
authors: Matteo
authors: M
authors: Bassetti
authors: Jan J
authors: JJ
authors: De Waele
authors: Philippe
authors: P
authors: Eggimann
authors: Josè
authors: J
authors: Garnacho-Montero
authors: Gunnar
authors: G
authors: Kahlmeter
authors: Francesco
authors: F
authors: Menichetti
authors: David P
authors: DP
authors: Nicolau
authors: Jose Arturo
authors: JA
authors: Paiva
authors: Mario
authors: M
authors: Tumbarello
authors: Tobias
authors: T
authors: Welte
authors: Mark
authors: M
authors: Wilcox
authors: Jean Ralph
authors: JR
authors: Zahar
authors: Garyphallia
authors: G
authors: Poulakou
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection / Q000188:drug therapy* / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D018805:Sepsis / Q000188:drug therapy* / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents