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Antimicrobial resistance in the intensive care unit: impact of new patterns
Abstract:
The effects of resistance are being observed on an increasing scale in the intensive care unit (ICU). Multi-resistant organisms are diminishing our ability to treat and control the spread of infection. Strategies for the control of resistant organisms in the ICU must be based on the underlying pathophysiology of resistance mechanisms. Resistance is also influenced by the setting in which health care is provided. In the United States (US), changes in the health care delivery system have had a dramatic impact on the number and type of ICU patients. Project ICARE (Intensive Care Antimicrobial Resistance Epidemiology) is a co-operative project to measure antibiotic resistance and antibiotic use. Results show a relative increase in the number of ICU beds in US hospitals. They also indicate a significant stepwise decrease in the percentage of resistant organisms isolated from ICU patients, non-ICU inpatients, and outpatients. These results suggest that resources allocated to control of antimicrobial resistance should continue to be focused on the hospital and particularly the ICU. Study findings also indicate that antimicrobial use and resistance are usually, but not always, linked. This means that strategies for dealing with resistance must address several additional factors including infection control practices, community burden of resistance, and possibly others. Thus national or regional guidelines for preventing resistance will have to be modified to take into account local care patterns, problems and resources. When dealing with resistance in the ICU, 'one size will not fit all'.
Insights
Antimicrobial resistance is a growing concern in intensive care units (ICUs). Project ICARE found that while ICU beds increased, resistant organism rates decreased, suggesting focused hospital and ICU interventions are key.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Increasing prevalence of antimicrobial resistance in Intensive Care Units (ICUs) poses a significant threat to infection control.
- Understanding the pathophysiology of resistance mechanisms and healthcare setting influences is crucial for effective strategies.
- Changes in US healthcare delivery have impacted ICU patient demographics and resistance patterns.
Purpose of the Study:
- To measure antibiotic resistance and antibiotic use in ICUs through Project ICARE (Intensive Care Antimicrobial Resistance Epidemiology).
- To analyze trends in antimicrobial resistance in relation to healthcare settings and antibiotic usage.
- To inform strategies for controlling antimicrobial resistance in ICUs.
Main Methods:
- Project ICARE, a co-operative study, collected data on antibiotic resistance and usage.
- Analysis of resistance patterns in ICU patients, non-ICU inpatients, and outpatients.
- Correlation of resistance trends with changes in healthcare delivery and ICU bed allocation.
Main Results:
- A relative increase in ICU beds in US hospitals was observed.
- A significant stepwise decrease in the percentage of resistant organisms was found across ICU, inpatient, and outpatient settings.
- Antimicrobial use and resistance are generally linked, but not universally.
Conclusions:
- Resources for controlling antimicrobial resistance should prioritize hospitals, especially ICUs.
- Effective resistance control requires addressing factors beyond antibiotic use, including infection control and community resistance burden.
- National or regional guidelines for resistance prevention need customization for local healthcare patterns and resources, as 'one size will not fit all' in ICUs.