Combatting Resistance in Intensive Care: The Multimodal Approach of the Spanish ICU “Zero Resistance” Program

Abstract

Over the last few decades, a dramatic worldwide increase in infection rates by multidrug-resistant (MDR) pathogens has occurred, which is acknowledged as a public health crisis [1]. Management of infections caused by these pathogens is often difficult due to the scarcity of available active drugs.

The last report of the European Antimicrobial Resistance Surveillance System (EARSS) network, which includes 30 European countries, describes a general European-wide increase in antimicrobial resistance for the Gram-negative pathogens under surveillance (Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa) [2]. High proportions of antimicrobial-resistant P. aeruginosa have been reported by many European countries [3]. In a study performed in 2000 in Spain, 41% of Acinetobacter baumannii isolates were resistant to carbapenems [4]. Indeed, the rate of carbapenem resistance has increased dramatically over the last decade, especially in the critical care setting [5]. An ominous emerging threat is the appearance of Gram-negative microorganisms harboring new beta-lactamases that confer high-level resistance to all available classes of beta-lactam antibiotics [6]. Concerning Gram-positive bacteria, methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus spp. resistant to vancomycin continue to be the most problematic pathogens. The incidence of MRSA infections seems to have remained stable over recent years, although this pathogen causes severe infections [2, 7].