Antibiotic resistance in the intensive care unit

The problem of antimicrobial resistance has increased significantly in the past decade and is now a major issue in most hospitals. A number of factors magnify this problem in the intensive care unit (ICU). These factors include the multiple invasive devices and procedures predisposing the ICU patient to infection, the widespread use of broad-spectrum antibiotics, lapse of infection control technique in the care of critically ill patients, and economic pressures that lead to understaffing. Antimicrobial resistance is a greater urgency for those multidrug-resistant organisms for which only a few antibiotic alternatives remain, such as vancomycin-resistant Enterococci and carbapenem-resistant Acinetobacter baumannii. Multiple drug resistance also increases health care costs, adds isolation precautions to the care of an already complicated patient, and results in inadequate empiric therapy that increases mortality. Understanding the current problems of antibiotic resistance will enhance the care and management of individual patients with these organisms in the ICU and lead to better prevention and control measures to decrease the prevalence of this problem.