Nosocomial infections in the ICU - The growing importance of antibiotic-resistant pathogens

Patients hospitalized in ICUs are 5 to 10 times more likely to acquire noso comial infections than other hospital patients. The frequency of infections at different anatomic sites and the risk of infection vary by the type of ICU, and the frequency of specific pathogens varies by infection site, Cont ributing to the seriousness of nosocomial infections, especially in ICUs, i s the increasing incidence of infections caused by antibiotic-resistant pat hogens. Prevention and control strategies have focused on methicillin-resis tant Staphylococcus aureus, vancomycin-resistant Enterococcus, and extended -spectrum beta-lactamase-producing Gram-negative bacilli, among others, An effective infection control program includes a surveillance system, proper handwashing, appropriate patient isolation, prompt evaluation and intervent ion when an outbreak occurs, adherence to standard guidelines on disinfecti on and sterilization, and an occupational health program for health-care pr oviders. Studies have shown that patients infected with resistant strains o f bacteria are more Likely than control patients to have received prior ant imicrobials, and hospital areas that have the highest prevalence of resista nce also have the highest rates of antibiotic use, For these reasons, progr ams to prevent or control the development of resistant organisms often focu s on the overuse or inappropriate use of antibiotics, for example, by restr iction of widely used broad-spectrum antibiotics (eg, third-generation ceph alosporins) and vancomycin, Other approaches are to rotate antibiotics used for empiric therapy and use combinations of drugs from different classes.