title: Antibiotic strategies in the era of multidrug resistance.
abstract: The rapid emergence and dissemination of antibiotic-resistant microorganisms in ICUs worldwide threaten adequate antibiotic coverage of infected patients in this environment. The causes of this problem are multifactorial, but the core issues are clear: the emergence of antibiotic resistance is highly correlated with selective pressure resulting from inappropriate use of these drugs. Because a significant increase in mortality is observed when antibiotic therapy is delayed in infected ICU patients, initial therapy should be broad enough to cover all likely pathogens. Receipt of unnecessary prolonged broad-spectrum antibiotics, however, should be avoided. Local microbiologic data are extremely important to predict the type of resistance that may be present for specific causative bacteria, as is prior antibiotic exposure, and antibiotic choices should thus be made at an individual patient level.
authors.affiliation: Infectious Disease Section, Louisiana State University School of Medicine, New Orleans, LA, 70112, USA.
authors.forename: George
authors.initials: G
authors.lastname: Karam
authors.affiliation: Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.affiliation: Department of Microbiology, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, LS1 3EX, UK.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Wilcox
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. jlvincent@intensive.org.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001419:Bacteria / Q000254:growth & development / Q000378:metabolism / Q000472:pathogenicity; D018432:Drug Resistance, Multiple / Q000187:drug effects*; D014943:Global Health / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration
chemical_list: D000900:Anti-Bacterial Agents