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Antibiotic-resistant gram-negative bacteria in the critical care setting
1Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Pediatric Clinics of North America
|June 1, 1995
Summary
Antibiotic-resistant gram-negative bacilli are an increasing threat in hospitals, particularly affecting critically ill patients. Patient-to-patient transmission via caregivers is a key factor, alongside organism and patient-specific elements.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Antibiotic-resistant gram-negative bacilli pose a significant and growing threat to hospitalized patients, especially those in intensive care settings.
- Outbreaks of these resistant pathogens have been documented in both neonatal intensive care units and adult intensive care units.
- The primary reservoir for these problematic bacteria in endemic settings is the patient, with transmission frequently occurring through healthcare worker contact.
Purpose of the Study:
- To highlight the increasing problem of antibiotic-resistant gram-negative bacilli in critically ill patients.
- To discuss the transmission dynamics and potential reservoirs of these pathogens.
- To explore the multifactorial nature of the emergence of antibiotic resistance.
Main Methods:
- This study is a review and synthesis of existing literature on antibiotic resistance in gram-negative bacilli.
- It analyzes reported outbreaks and transmission patterns in healthcare settings.
- It discusses the interplay between antibiotic use, organism characteristics, and patient factors.
Main Results:
- Gram-negative bacilli resistant to common antibiotics are a growing concern in critically ill, hospitalized populations.
- Patient-to-patient transmission, often facilitated by healthcare worker hand hygiene, is a significant route of spread.
- While antibiotic use is implicated, its precise role is not fully elucidated, suggesting other factors are also crucial.
Conclusions:
- The emergence and spread of antibiotic-resistant gram-negative bacilli are complex issues influenced by multiple factors.
- Effective control strategies must address patient reservoirs, transmission routes (including caregiver practices), and potentially intrinsic microbial and host factors.
- Further research is needed to fully understand the relationship between antibiotic stewardship and the development of resistance in these critical care settings.