Chart 1- ESKAPE pathogens E Enterococcus faecium (VRE) S Staphylococcus aureus (MRSA) K Klebsiella and Escherichia coli producing ESBL A Acinetobacter baumannii P Pseudomonas aeruginosa E Enterobacteriaceae

Infections caused by potentially drug-resistant pathogens steadily increase in intensive care units (ICUs) and are a major cause of overall prevalence in hospitals. Resistance is likely because ICU patients often have complex illnesses and use many antibiotics.(1,2) Indeed, more than 70% of critically ill patients will be given an antimicrobial drug during their ICU stay.(1) In addition, infections are highly involved in ICU morbidity and mortality; the prevalence of infections caused by germs that require progressively more complex therapy has grown in recent years.(1-3) Additionally, although multidrug-resistant germs are a worldwide problem, their mechanisms of resistance and sensitivity patterns vary widely across different regions, making any generalization difficult.(4) In recent years, the surge of drug resistance has become a challenge for hospital systems.(2) The exposure to antimicrobials and resultant inappropriate use are the primary factors related to the development of resistance. The main pathogens associated with nosocomial infection, together representing higher therapeutic-limiting resistance risks, were grouped in an acronym known as ESKAPE (Chart 1).(2) Although the mechanisms of resistance are not the same, all ESKAPE pathogens share a growing prevalence due to the selective pressure from policies (or their absence) for antimicrobial use, particularly in ICUs. In addition, the development of new drugs able to broaden our therapeutic armamentarium is very limited, as no drugs are currently under development for most of the ESKAPE germs, especially for the gram-negative pathogens.(5)