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- Title
Bugs, hosts and ICU environment: Countering pan-resistance in nosocomial microbiota and treating bacterial infections in the critical care setting.
- Authors
Maseda, Emilio; Mensa, José; Valía, Juan-Carlos; Gomez-Herreras, Jose-Ignacio; Ramasco, Fernando; Samso, Enric; Chiveli, Miguel-Angel; Pereira, Jorge; González, Rafael; Aguilar, Gerardo; Tamayo, Gonzalo; Ojeda, Nazario; Rico, Jesús; Gimenez, María José; Aguilar, Lorenzo
- Abstract
ICUs are areas where resistance problems are the largest, and they constitutes a major problem for the intensivist's clinical practice. Main resistance phenotypes among nosocomial microbiota are: i) vancomycin-resistance/heteroresistance and tolerance in grampositives (MRSA, enterococci) and ii) efflux pumps/enzymatic resistance mechanisms (ESBLs, AmpC, metallobetalactamases) in gramnegatives. These phenotypes are found at different rates in pathogens causing respiratory (nosocomial pneumonia/ventilator-associated pneumonia), bloodstream (primary bacteremia/catheter-associated bacteremia), urinary, intraabdominal and surgical wound infections and endocarditis in the ICU. New antibiotics are available to overcome non-susceptibility in grampositives; however, accumulation of resistance traits in gramnegatives has lead to multidrug resistance, a worrisome problem nowadays. This article reviews by microorganism/infection risk factors for multidrug resistance, suggesting adequate empirical treatments. Drugs, patient and environmental factors all play a role in the decision to prescribe/recommend antibiotic regimens in the specific ICU patient, implying that intensivists should be familiar with available drugs, environmental epidemiology and patient factors.
- Subjects
INTENSIVE care units; VANCOMYCIN resistance; NOSOCOMIAL infections; BACTEREMIA; ANTIBIOTICS
- Publication
Revista Española de Quimioterapia, 2013, Vol 26, Issue 4, p312
- ISSN
0214-3429
- Publication type
Article