Drug resistance in intensive care units

Intensive care units (ICUs) are generally considered epicenters of antibiot ic resistance and the principal sources of outbreaks of multi-resistant bac teria. The most important risk factors are obvious, such as excessive consu mption of antibiotics exerting selective pressure on bacteria, the frequent use of invasive devices and relative density of a susceptible patient popu lation with severe underlying diseases. Infections due to antibiotic-resist ant bacteria have a major impact on morbidity and health-care costs, Increa sed mortality is not uniformly shown for all of these organisms: Methicilli n-resistant Staphylococcus aureus (MRSA) seems to cause significantly highe r mortality, in contrast to vancomycin-resistant enterococci (VRE). Therefo re it is essential to diminish these potential risk factors, especially by providing locally adapted guidelines for the prudent use of antibiotic ther apy. A quality control of antimicrobial therapy within a hospital, and espe cially within the ICU, might help to minimize the selection of multidrug-re sistant bacteria. The restricted use of antimicrobial agents in prophylaxis and therapy has also been shown to have at least temporal effects on local resistance patterns. New approaches to the problem of drug resistance in I CUs are badly needed.