What’s new in antimicrobial use and resistance in critically ill patients?

Excerpt

Infection is a major factor impacting the clinical outcome among patients requiring intensive care unit (ICU) support. The causes of infection in the ICU are multifactorial, and the consequences depend on the source involved, the associated organisms, the underlying morbidity, and the timeliness and appropriateness of the treatment or interventions received. The causative organisms for infections have evolved over the years. The recent French EPISS study showed an incidence of 13.5 % in episodes of septic shock among ICU patients [1]. Strikingly, around 50 % of the microbial isolates were Gram-negative bacteria, displaying a reversal of the pattern seen in previous studies in which Gram-positive bacteria predominated. Approximately two-thirds of patients presented community-acquired infections, and more than half had respiratory tract infections as the primary site of infection for the origin of the septic shock [1]. In the same study the authors reported a significant reduction in mortality by approximately 17 % between 2000 and 2011. The data suggests that infection management has improved over the last decade, and undoubtedly, the publication of international clinical practice guidelines for management contributed to this trend [2]. In the EUROBACT study the most frequently isolated pathogens from bloodstream infections were Gram-negatives: Acinetobacter spp., Klebsiella spp., and Pseudomonas spp. [3]. All three pathogens reflected the phenomenon of growing resistance summarized by the acronym ‘ESCAPE’, containing the initials of the most frequent multidrug-resistant (MDR) microorganisms (Enterococcus faecium, Staphylococcus aureus, Clostridium difficile, Acinetobacter baumannii, and Enterobacteriaceae). The phenomenon of MDR organisms is ubiquitous, as three-quarters of European countries have reported at least one extensively drug-resistant (XDR) organisms in ICU patients [4]. …