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Antimicrobial Resistance

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Infection Control in the Intensive Care Unit

Abstract

The concept of exposing vast numbers of critically ill patients to broad-spectrum multiple-drug cocktails runs counter to existing theoretical models. The dynamics of resistance are driven by three mechanisms: import; acquisition; de novo development. Gut overgrowth is a risk factor for de novo resistance development. Each mechanism is responsible for one third of antimicrobial resistance, the common denominator being gut overgrowth. There are four categories in which antimicrobial resistance is a problem in intensive care: aerobic Gram-negative bacilli; methicillin-resistant Staphylococcus aureus; azole-resistant Candida spp.; vancomycin-resistant enterococci. Five randomised controlled trials of selective decontamination of the digestive tract (SDD) have been meta-analysed with the endpoint of resistance: 2.8% of patients had resistant microorganisms in the SDD group, and 4.8% in controls, indicating a 44% reduction in the odds of resistance by SDD. The mechanism of action is almost certainly gut overgrowth control by the enterally administered antimicrobials, the essential component of SDD.

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Authors and Affiliations

  1. Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, Merseyside, UK

    N. Taylor

  2. Intensive Care Unit, Hospital Universitario de Getafe, Getafe, Madrid, Spain

    I. Cortés Puch

  3. Department of Emergency, Hospital Gorizia, Unit Anesthesia and Intensive Care, Gorizia, Italy

    L. Silvestri

  4. Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands

    D. F. Zandstra

  5. Institute of Ageing and Chronic Diseases, University of Liverpool, Duncan Building, Liverpool, UK

    H. K. F. van Saene

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  1. N. Taylor
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  2. I. Cortés Puch
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  3. L. Silvestri
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  4. D. F. Zandstra
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  5. H. K. F. van Saene
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Correspondence to N. Taylor .

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Editors and Affiliations

  1. , Institute of Aging and Chronic Diseases, University Liverpool, Daulby Street, Liverpool, L69 3GA, United Kingdom

    Hendrick K.F. van Saene

  2. , Dept. Emergency, Hospital Gorizia, Via Vittorio Veneto 171, Gorizia, 34170, Italy

    Luciano Silvestri

  3. , Department of Intensive Care Medicine, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, 28045, Spain

    Miguel A. de la Cal

  4. Policlinico di Catania, UCO di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria, Via Santa Sofia 78, Catania, 95100, Italy

    Antonino Gullo

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Taylor, N., Cortés Puch, I., Silvestri, L., Zandstra, D.F., van Saene, H.K.F. (2011). Antimicrobial Resistance. In: van Saene, H., Silvestri, L., de la Cal, M., Gullo, A. (eds) Infection Control in the Intensive Care Unit. Springer, Milano. https://doi.org/10.1007/978-88-470-1601-9_28

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