NJCC_02 bwerk v4.indd

Objective: This review discusses the impact of antibiotic resistance in the intensive care unit (ICU), including the prevalence, morbidity, antibiotic resistance patterns and factors perpetuating antibiotic resistance. In addition, this describes the clinical significance of antibiotic resistance, the mechanisms of resistance, and suggests strategies to combat resistance. Summary: Antibiotic resistance is a major problem steadily on the rise, especially in the ICU. The impact of antibiotic resistance on mortality is not clear, but it has been shown to increase morbidity and ICU stay, hospital stay, and costs. The main resistant organisms are nosocomial organisms, such as Pseudomonas aeruginosa, and Acinetobacter, but resistance is increasing in the outpatient setting and chronic care facilities. High volume and potentially indiscriminate use of antimicrobials in the ICU setting, combined with the increased incidence of infection associated with invasive nature of modalities used in intensive care, and poor de-escalation strategies are the most important causes of increasing resistance. The intensivist is faced with reconciling the difficult aims of influencing mortality by using the best and most powerful, broadest spectrum antimicrobial available, and yet limiting their use to prevent future consequences of antibiotic resistance. Multiple strategies are discussed, such as appropriate antibiotic use; changing antibiotics periodically using antibiotic restriction and antibiotic cycling; limiting antibiotics using active de-escalation measures; combination therapy; selective digestive decontamination; intensive local monitoring of microbial prevalence and antibiotic resistance patterns; control of antibiotic use in animal industry; and novel ideas such as computer assisted programmes. Conclusion This problem has reached epidemic proportions with some of the multi-drug resistant (MDR) organisms such as MRSA and needs to be controlled using appropriate strategies, applied uniquely to local situations, with commitment by every healthcare personnel involved