Bugs, hosts and ICU environment: countering pan-resistance in nosocomial microbiota and treating bacterial infections in the critical care setting.
Autors de IIS La Fe
Autors aliens a IIS La Fe
- Maseda E
- Mensa J
- Valia JC
- Gomez-Herreras JI
- Ramasco F
- Samso E
- Pereira J
- Gonzalez R
- Aguilar G
- Tamayo G
- Ojeda N
- Rico J
- Gimenez MJ
- Aguilar L
Abstract
ICUs are areas where resistance problems are the largest, and these constitute 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, metallo-betalactamases) 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 led to multidrug resistance, a worrisome problem nowadays. This article reviews 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.
Dades de la publicació
- ISSN/ISSNe:
- 0034-9356, 2340-3284
- Tipus:
- Article
- Pàgines:
- 1-19
- PubMed:
- 24492197
- Factor d'Impacte:
- 0,195 SCImago ℠
- Quartil:
- Q3 SCImago ℠
Revista espanola de anestesiologia y reanimacion ELSEVIER SCIENCE BV
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Filiacions
Keywords
- Acinetobacter baumannii; Betalactamasas de espectro prolongado; Critical care; Cuidados criticos; Enterococo resistente a vancomicina; Extended spectrum beta-lactamase; Methicillin-resistant Staphylococcus aureus; Pseudomonas aeruginosa; Staphycoccus aureus resistente a meticilina; Vancomycin-resistant enterococci