Antibiotic resistance in the intensive care unit

Abstract

The use of antibiotics is unique in medical practice in that the treatment given to an individual may have consequence for the wider population. Pathogens may be intrinsically resistant to antibiotics, but the problem of induced or evolving resistance should not to be underestimated. Increasingly, it is recognized that the use of broad-spectrum agents, even when appropriate, is a significant factor in the development of resistance in bacteria and fungi. This has major implications for healthcare in general, and particularly in the ICU where resistant organisms can present major challenges, as patients tend to be debilitated and particularly susceptible to nosocomial infection. Such infections often lead to prolonged ICU and hospital stay, and consequent increased healthcare costs. There is a degree of inevitability to the development of antibiotic resistance. However, strategies have been proposed and evaluated that attempt to limit the development of antimicrobial resistance, maintain the usefulness of existing antimicrobials, and influence the development of novel agents. Much of what follows relates to bacterial resistance and pathogens selected by antibiotic use.