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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access published online on June 26, 2009
Continuing Education in Anaesthesia, Critical Care & Pain, doi:10.1093/bjaceaccp/mkp017
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Antibiotic resistance in the intensive care unit

A. J. Varley, BSc MRCS FRCA
Senior Registrar, Intensive Care Unit
Alfred Hospital
Melbourne, VIC
Australia

H. Williams, MB BCh FRCPath
Consultant Microbiologist
Norfolk and Norwich University Hospital
Colney, Norwich, UK

S. Fletcher, FRCA FRCPE
Consultant in Anaesthesia and Intensive Care
Norfolk and Norwich University Hospital
Colney, Norwich, UK
E-mail: simon.fletcher@nnuh.nhs.uk

The first 150 words of the full text of this article appear below.


Key points

Gene transfer is the predominant mechanism of acquisition of resistance.
The use of broad-spectrum agents is a significant factor in the development of resistance in bacteria and fungi.
The risk of acquiring infection with antibiotic resistant organisms is positively correlated with increasing age, illness severity, debility, and length of ICU stay.
No single measure can be effective in the prevention of infection due to antibiotic resistant organisms or in the reduction of resistance.
Knowledge of the mechanism of transmission of resistance enables targeted efforts to control outbreaks.

 

The use of antibiotics is unique in medical practice in that the treatment given to an individual may have consequence for the wider population. Pathogens may be intrinsically resistant to antibiotics, but the problem of induced or evolving resistance should not to be underestimated. Increasingly, it is recognized that the use of broad-spectrum agents, even when appropriate, is a significant factor . . . [Full Text of this Article]


   Bugs, drugs, and the patient
 

   Molecular genetics of antibiotic resistance
 

   Mechanisms
 

   The problem of resistance
 

   Common resistance problems
 
Methicillin-resistant Staphylococcus aureus

Extended-spectrum β-lactamase-producing organisms

Vancomycin-resistant Enterococci

Other Gram –ve organisms


   Management strategies
 
Selective decontamination of the digestive tract

Antibiotic cycling

Restrictive antibiotic strategies

De-escalation

Microflora surveillance

The importance of correct dosing


   Clostridium difficile
 

   Practical measures
 

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