Antimicrobial resistance and outcome in the critically ill patient: An opinion paper

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Epidemiology

Background:

• Antimicrobial resistance (AMR) contributes to increased mortality and resource use in critically ill patients.
• The direct causal link between AMR and mortality in this population remains incompletely understood.
• Multidrug-resistant (MDR) pathogens are a growing concern in intensive care settings.

Purpose of the Study:

• To provide an overview of the impact of MDR pathogens on critically ill patient outcomes.
• To examine confounding variables influencing the association between MDR pathogens and mortality.
• To highlight areas for future research in antimicrobial stewardship and patient outcomes.

Main Methods:

• This paper presents an opinion and overview based on existing literature and large database studies.
• It considers factors such as appropriateness of empirical antimicrobial therapy.
• It also analyzes the influence of sepsis severity, comorbid conditions, and patient frailty.

Main Results:

• Large studies associate MDR pathogens with increased mortality in critically ill patients.
• Patients with MDR pathogens often have more comorbidities, higher frailty, and undergo invasive procedures.
• These patients are also more likely to receive inappropriate empirical antibiotics and have life-sustaining therapy withdrawn.

Conclusions:

• The association between MDR pathogens and mortality in critically ill patients is complex and multifactorial.
• Confounding factors, including patient characteristics and treatment decisions, must be considered.
• Future research should meticulously report the appropriateness of empirical antimicrobial therapy and end-of-life care decisions.