LOWER RESPIRATORY-TRACT INFECTIONS IN THE INTENSIVE-CARE UNIT - CONSEQUENCES OF ANTIBIOTIC-RESISTANCE FOR CHOICE OF ANTIBIOTIC

Pneumonia in the intensive care unit (ICU) has been associated with hi ghly virulent pathogens that often exhibit resistance to multiple anti biotics and mortality rates of 30-70%. Pseudomonas aeruginosa and Ente robacteriaceae are the leading pathogens, followed by Staphylococcus a ureus and polymicrobial etiologies, Recent clinical studies using mono therapy for nosocomial pneumonias resulted in low eradication rates fo r P. aeruginosa and staphylococci, An additional problem of these stud ies was the development of resistance by P. aeruginosa during the anti biotic treatment; also the selection of highly resistant strains like Xanthomonas maltophilia and Acinetobacter species was a major concern, However, several prospective studies comparing monotherapy versus com bination therapy in nosocomial pneumonia of ICU patients have shown th at a response rate of 60% is achievable, which is comparable to histor ic rates for combination therapy regimens, Only infections induced by P. aeruginosa, S. aureus, or other highly resistant pathogens (Acineto bacter, X. maltophilia, etc.) should be treated with well-defined anti biotic combinations.