Intensive Care Medicine

, Volume 43, Issue 10, pp 1464–1475 | Cite as

Antimicrobial resistance in the next 30 years, humankind, bugs and drugs: a visionary approach

  • Matteo BassettiEmail author
  • Garyphallia Poulakou
  • Etienne Ruppe
  • Emilio Bouza
  • Sebastian J. Van Hal
  • Adrian Brink



To describe the current standards of care and major recent advances with regard to antimicrobial resistance (AMR) and to give a prospective overview for the next 30 years in this field.


Review of medical literature and expert opinion were used in the development of this review.


There is undoubtedly a large clinical and public health burden associated with AMR in ICU, but it is challenging to quantify the associated excess morbidity and mortality. In the last decade, antibiotic stewardship and infection prevention and control have been unable to prevent the rapid spread of resistant Gram-negative bacteria (GNB), in particular carbapenem-resistant Pseudomonas aeruginosa (and other non-fermenting GNB), extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant Enterobacteriaceae (CRE). The situation appears more optimistic currently for Gram-positive, where Staphylococcus aureus, and particularly methicillin-resistant S. aureus (MRSA), remains a cardinal cause of healthcare-associated infections worldwide. Recent advancements in laboratory techniques allow for a rapid identification of the infecting pathogen and antibiotic susceptibility testing. Their impact can be particularly relevant in settings with prevalence of MDR, since they may guide fine-tuning of empirically selected regimen, facilitate de-escalation of unnecessary antimicrobials, and support infection control decisions.

Currently, antibiotics are the primary anti-infective solution for patients with known or suspected MDR bacteria in intensive care. Numerous incentives have been provided to encourage researchers to work on alternative strategies to reverse this trend and to provide a means to treat these pathogens. Although some promising antibiotics currently in phase 2 and 3 of development will soon be licensed and utilized in ICU, the continuous development of an alternative generation of compounds is extremely important. There are currently several promising avenues available to fight antibiotic resistance, such as faecal microbiota, and phage therapy.


Antimicrobial resistance Antibiotics Diagnostic test Microbiota Phage therapy Vaccine 



Antimicrobial resistant


Antibiotic stewardship


Antibiotic susceptibility testing


Colonisation resistance


Carbapenem-resistant Enterobacteriaceae


Extended-spectrum β-lactamase


Gram-negative bacilli


Gram-positive cocci


Health-care associated infections


Intensive care unit


Infecting pathogen


Linezolid resistant


Multi-drug resistant


Methicillin-resistant Staphylococcus aureus


Infection prevention and control


Vancomycin-intermediate Staphylococcus aureus


Vancomycin-resistant enterococci


Whole genome sequencing


Extensively-drug resistant


Compliance with ethical standards

Conflicts of interest

MB serves on scientific advisory boards for AstraZeneca, Bayer, Cubist, Pfizer Inc, MSD, Tetraphase and Astellas Pharma Inc.; has received funding for travel or speaker honoraria from Algorithm, Angelini, Astellas Pharma Inc., AstraZeneca, Cubist, Pfizer MSD, Gilead Sciences, Novartis, Ranbaxy, Teva. ER serves on the scientific board of MaaT Pharma, and is consultant for DaVolterra. AB serves on advisory board for MSD and Takeda pharmaceuticals and speaker’s bureau for Pfizer, MSD and Sanofi-aventis. The other authors declare that they have no conflict of interest.


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Authors and Affiliations

  1. 1.Department of Medicine, Infectious Diseases ClinicUniversity of Udine and Azienda Sanitaria Universitaria IntegrataUdineItaly
  2. 2.Fourth Department of Internal Medicine, School of Medicine, Attikon University General HospitalAthens National and Kapodistrian UniversityAthensGreece
  3. 3.Genomic Research Laboratory, Division of Infectious DiseasesGeneva University HospitalsGenevaSwitzerland
  4. 4.Department of Clinical Microbiology and Infectious DiseasesHospital General Universitario Gregorio MarañónMadridSpain
  5. 5.Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
  6. 6.Department of Medicine, School of MedicineUniversidad Complutense de MadridMadridSpain
  7. 7.CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058)MadridSpain
  8. 8.Department of Microbiology and Infectious DiseasesRoyal Prince Alfred HospitalSydneyAustralia
  9. 9.Ampath National Laboratory Services, Department of Clinical MicrobiologyMilpark HospitalJohannesburgSouth Africa
  10. 10.Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur HospitalUniversity of Cape TownCape TownSouth Africa

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