Summary
Intensive care units (ICUs) are generally considered epicenters of antibiotic resistance and the principal sources of outbreaks of multi-resistant bacteria. The most important risk factors are obvious, such as excessive consumption of antibiotics exerting selective pressure on bacteria, the frequent use of invasive devices and relative density of a susceptible patient population with severe underlying diseases. Infections due to antibiotic-resistant bacteria have a major impact on morbidity and health-care costs. Increased mortality is not uniformly shown for all of these organisms: Methicillin-resistantStaphylococcus aureus (MRSA) seems to cause significantly higher mortality, in contrast to vancomycin-resistant enterococci (VRE). Therefore it is essential to diminish these potential risk factors, especially by providing locally adapted guidelines for the prudent use of antibiotic therapy. A quality control of antimicrobial therapy within a hospital, and especially within the ICU, might help to minimize the selection of multidrug-resistant bacteria. The restricted use of antimicrobial agents in prophylaxis and therapy has also been shown to have at least temporal effects on local resistance patterns. New approaches to the problem of drug resistance in ICUs are badly needed.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Vincent, J. L., Bihari, D. J., Suter, P. M., Bruining, H. A., White, J., Nicolas-Cahnoi, M. H., Wolff, M., Spencer, R. C., Hemmer, M., for the EPIC International Advisory Committee: The prevalence of nosocomial infection in intensive care units in Europe. Results of the European prevalence of infection in intensive care (EPIC) study. JAMA 274 (1995) 639–644.
Richards, M. J., Edwards, J. R., Culver, D. H., Gaynes, R. P., the National Nosocomial Infections Surveillance System: Nosocomial infections in coronary care units in the United States. Am. J. Cardiol. 82 (1998) 789–793.
Craven, D. E., Kunches, L. M., Lichtenberg, D. A., Kollisch, N. R., Barry, A., Heeren, T. C., McCabe, W. R.: Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch. Intern. Med. 148 (1988) 1161–1168.
Namias, N., Harvill, S., Ball, S., McKenney, M. G., Salomone, J. P., Sleeman, D., Civetta, J. M.: Empiric therapy of sepsis in the surgical intensive care unit with broad-spectrum antibiotics for 72 hours does not lead to the emergence of resistant bacteria. J. Trauma 45 (1998) 887–891.
Wheeler, A. P., Bernard, G. R.: Treating patients with severe sepsis. N. Engl. J. Med. 340 (1999) 207–214.
Lucet, J. C., Chevret, S., Decre, D.: Outbreak of multiply resistant Enterobacteriaceae in an intensive care unit: epidemiology and risk factors for acquisition. Clin. Infect. Dis. 22 (1996) 430–436.
Quinn, J. P.: Clinical problems posed by nonfermenting gram-negative pathogens. Clin. Infect. Dis. 27 (Suppl. 1) (1998) 117–124.
Jarlier, V., Fosse, T., Philippon, A., ICU Study Group: Antibiotic susceptibility in aerobic gram-negative bacilli isolated in intensive care units in 39 French teaching hospitals (ICU study). Intensive Care Med. 22 (1996) 1057–1065.
McGowan, J., Tenover, F.: Antimicrobial resistance in the intensive care unit: impact of new patterns. Int. J. Clin. Pract. (Suppl. 95) (1998) 14–22.
Drusano, G. L.: Infection in the intensive care unit: β-lactamase-mediated resistance amongEnterobacteriaceae and optimal antimicrobial dosing. Clin. Infect. Dis. 27 (Suppl. 1) (1998) 111–116.
Piroth, L., Aube, H., Doise, J. M., Vincent-Martin, M.: Spread of extended-spectrum β-lactamase-producingKlebsiella pneumoniae: are β-lactamase inhibitors of therapeutic value? Clin. Infect. Dis. 27 (1998) 76–80.
Spencer, R. C., for the International Study Group: Cross-susceptibility of cefpirome and four other β-lactams against isolates from haematology/oncology and intensive care units. Scand. J. Infect. Dis. (Suppl. 91) (1993) 25–32.
Ibelings, M. M., Bruining, H. A.: Methicillin-resistantStaphylococcus aureus: acquisition and risk of death in patients in the intensive care unit. Eur. J. Surg. 164 (1998) 411–418.
Conterno, L. O., Wey, S. B., Castelo, A.: Risk factors for mortality inStaphylococcus aureus bacteremia. Infect. Control Hosp. Epidemiol. 19 (1998) 32–37.
Harbarth, S., Rutschmann, O., Sudre, P., Pittet, D.: Impact of methicillin resistance on the outcome of patients with bacteremia caused byStaphylococcus aureus. Arch. Intern. Med. 26 (1998) 182–189.
Mainous, M. R., Lipsett, P. A., O'Brien, M.: Enterococcal bacteremia in the surgical intensive care unit. Does vancomycin resistance affect mortality? The Johns Hopkins SICU Study Group. Arch. Surg. 132 (1997) 76–81.
Edmond, M. B., Ober, J. F., Dawson, J. D., Weinbaum, D. L., Wenzel, R. P.: Vancomycin-resistant enterococcal bacteremia: natural history and attributable mortality. Clin. Infect. Dis. 23 (1996) 1234–1239.
Snydman, D. R.: Clinical implications of multi-drug resistance in the intensive care unit. Scand. J. Infect. Dis. (Suppl. 78) (1991) 54–63.
Alvarez-Lerma, F., ICU-Acquired Pneumonia Study Group: Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. Intensive Care Med. 22 (1996) 387–394.
Moellering, R. C. Jr.: Antibiotic resistance. Lessons for the future. Clin. Infect. Dis. 27 (Suppl. 1) (1998) 135–140.
Kollef, M. H., Vlasnik, J., Sharpless, L., Pasque, C., Murphy, D., Fraser, V.: Scheduled change of antibiotic classes: a strategy to decrease the incidence of ventilator-associated pneumonia. Am. J. Respir. Crit. Care Med. 156 (1997) 1040–1048.
Nathans, A. B., Marshall, J. C.: Selective decontamination of the digestive tract in surgical patients: a systematic review of the evidence. Arch. Surg. 134 (1999) 170–176.
The Erlanger Silver Catheter: Infection Suppl. 1 (1999) 1–80.
Darouiche, R. O., Raad, I. I., Heard, S. O., Thornby, J. I., Wenker, O. C., Gabrielli, A., Berg, J., Khardori, N., Hanna, H., Hachem, R., Harris, R. L., Mayhall, G. for the Catheter Study Group: A comparison of two antimicrobial-impregnated central venous catheters. N. Engl. J. Med. 340 (1999) 1–8.
Spencer, R. C.: Predominant pathogens found in the European Prevalence of Infection in Intensive Care Study. Eur. J. Clin. Microbiol. Infect. Dis. 15 (1996) 281–285.
Tornieporth, N. G., Roberts, R. B., John, J., Hafner, A., Riley, L. W.: Risk factors associated with vancomycin-resistantEnterococcus faecium infection or colonization in 145 matched case patients and control patients. Clin. Infect. Dis. 23 (1996) 767–772.
Slaughter, S., Hayden, M. K., Nathan, C., Hu, T. C., Rice, T., v. Voorhis, J., Matushek, M., Franklin, C., Weinstein, R. A.: A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann. Intern. Med. 125 (1996) 448–456.
Bonten, M. J. M., Slaughter, S., Hayden, M. K., Nathan, C., v. Voorhis, J., Weinstein, R. A.: External sources of vancomycin-resistant enterococci for intensive care units. Crit. Care Med. 26 (1998) 2001–2004.
Doebbeling, B. N., Stanley, G. L., Sheetz, C. T., Pfaller, M. A., Houston, A. K., Annis, L., Li, L., Wenzel, R. P.: Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N. Engl. J. Med. 327 (1992) 88–93.
Moellering, R. C. Jr.: Interaction between antimicrobial consumption and selection of resistant bacterial strains. Scand. J. Infect. Dis. 70 (Suppl.) (1990) 18–24.
McGowan, J. E. Jr.: Do intensive hospital antibiotic control programs prevent the spread of antibiotic resistance? Infect. Control Hosp. Epidemiol. 15 (1994) 478–483.
Dagan, O., Cox, P. N., Ford-Jones, L., Ponsonby, J., Bohn, D. J.: Nosocomial infection following cardiovascular surgery: comparison of two periods, 1987 vs. 1992. Crit. Care Med. 27 (1999) 104–108.
Evans, R. S., Pestotnik, S. L., Classen, D. C., Clemmer, T. P., Weaver, L. K., Orme, J. F., Lloyd, J. F., Burke, J. P.: A computer-assisted management program for antibiotics and other antiinfective agents. N. Engl. J. Med. 338 (1998) 232–238.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Albrich, W.C., Angstwurm, M., Bader, L. et al. Drug resistance in intensive care units. Infection 27 (Suppl 2), S19–S23 (1999). https://doi.org/10.1007/BF02561665
Issue Date:
DOI: https://doi.org/10.1007/BF02561665