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Antimicrobial resistance in the intensive care unit.
1Department of Medicine, New England Deaconess Hospital, Harvard Medical School, Boston, MA 02215.
Seminars in Respiratory Infections
|September 1, 1990
Summary
Antimicrobial resistance is a significant challenge in intensive care units, driven by bacterial mechanisms like altered drug targets and inactivation. Limiting antimicrobial use and employing appropriate dosing strategies are key to combating resistant bacterial infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Antimicrobial resistance (AMR) poses a critical threat in intensive care units (ICUs).
- Existing potent antibiotics and infection control measures have not fully curbed AMR.
- Understanding resistance mechanisms is crucial for effective treatment.
Purpose of the Study:
- To review the mechanisms of antimicrobial resistance in ICUs.
- To identify key bacterial pathogens exhibiting resistance.
- To outline strategies for minimizing the evolution and spread of resistant bacteria.
Main Methods:
- Literature review of antimicrobial resistance mechanisms.
- Analysis of bacterial resistance traits (chromosomal vs. plasmid-mediated).
- Identification of clinically significant resistant bacteria.
Main Results:
- Common resistance mechanisms include impaired permeability, inactivation, and target site alteration.
- Resistance can be chromosomally or plasmid/transposon-mediated, facilitating multi-drug resistance and spread.
- Key problematic bacteria include MRSA, VRE, Enterobacteriaceae, Pseudomonas aeruginosa, P. cepacia, and X. maltophilia.
Conclusions:
- Judicious antimicrobial use, including dose optimization and avoiding rapidly resistance-inducing drugs, is essential.
- Strategic antimicrobial stewardship can help mitigate the emergence and dissemination of resistant isolates.
- Continued vigilance and targeted interventions are necessary to manage AMR in critical care settings.