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.
Highlights
ICU patients are at risk of developing infections with multidrug-resistant (MDR) organisms, which are more prevalent in this environment
The increased prevalence of carbapenem-resistant Enterobacteriaceae (CRE), in K. pneumoniae which has seen near untreatable infections occurring in an increasing number of hospitals, is of concern
The results suggest that amoxicillin–clavulanic acid (AMC) and PTZ are suitable alternatives to carbapenems for treating patients with bloodstream infections due to extended-spectrum β-lactamase (ESBL)-producing E. coli if there is in vitro activity
Summary
ICU patients are at risk of developing infections with multidrug-resistant (MDR) organisms, which are more prevalent in this environment. Analogous mechanisms of resistance occur with classes of antibiotics that are increasingly being used to manage infections due to bacteria resistant to β-lactam antibiotics (Table 1). By contrast to β-lactam antibiotics, which have their mechanisms of action and resistance located within the cell wall of the bacteria, the location of binding sites and modifying enzymes of the other antibiotic classes described in Table 1 are intracellular. Knowledge of this variability of action and resistance mechanisms can contribute to informed decisions in the selection of antimicrobial therapy for resistant organisms. Extended-spectrum β-lactamases (ESBLs) are broadspectrum enzymes produced most characteristically by
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