Bugs, hosts and ICU environment: Countering pan-resistance in nosocomial microbiota and treating bacterial infections in the critical care setting

摘要: ICUs are areas where resistance problems the largest, and these constitute a major problem for intensivist's clinical practice. Main phenotypes among nosocomial microbiota (i) vancomycin-resistance/heteroresistance tolerance in grampositives (MRSA, enterococci) (ii) efflux pumps/enzymatic mechanisms (ESBLs, AmpC, metallo-betalactamases) gramnegatives. These found at different rates pathogens causing respiratory (nosocomial pneumonia/ventilator-associated pneumonia), bloodstream (primary bacteremia/catheter-associated bacteremia), urinary, intraabdominal surgical wound infections endocarditis ICU. New antibiotics available to overcome non-susceptibility grampositives; however, accumulation of traits gramnegatives has led multidrug resistance, worrisome nowadays. This article reviews microorganism/infection risk factors suggesting adequate empirical treatments. Drugs, patient environmental all play role decision prescribe/recommend antibiotic regimens specific ICU patient, implying that intensivists should be familiar with drugs, epidemiology factors.