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Risks for multidrug-resistant pathogens in the ICU

Martín-Loeches, Ignacioa,b; Diaz, Emilib; Vallés, Jordib

Current Opinion in Critical Care: October 2014 - Volume 20 - Issue 5 - p 516–524
doi: 10.1097/MCC.0000000000000124
INFECTIOUS DISEASES: Edited by Michael S. Niederman

Purpose of review The impact of multidrug-resistant organisms (MDROs) is rising and often underestimated. The epidemiology of MDROs is extremely complex and multifactorial. There is increasing antibiotic resistance, mainly related to antibiotic pressure and patients’ characteristics.

Recent findings Emphasis on MDRO epidemiology is needed to better understand current strategies of prevention and management. Among them, antibiotic stewardship has been one of the most successful strategies. It is important to note that there is a controversial issue when considering community and healthcare-related infections. In addition, different strategies have been determined to find the impact and optimal use of recently launched antibiotics for MDRO treatment.

Summary Infections with MDROs can prolong hospital stay, promote antibiotic use and prolong duration of mechanical ventilation. Some points should be further explored in clinical research such as the heterogeneity of healthcare-associated pneumonia and the need of new drug development. Resistance to non fermentative Gram-negative bacilli, rising minimum inhibitory concentration in methicillin-resistant Staphylococcus aureus and spread of MDROs in patients without known risk factors suggest a review of guideline validation, taking into account ecology and severity of patient illness to provide timely and appropriate empiric therapy.

aMultidisciplinary Intensive Care Research Organization, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland

bCorporació Sanitária I Universitaria Parc Taulí - Hospital De Sabadell, Institut Universitari UAB, Ciber Enfermedades Respiratorias, Sabadell, Barcelona, Spain

Correspondence to Ignacio Martín-Loeches, MD, PhD, St. James's Hospital, James's Street, Dublin 8, Ireland. Tel: +353 (01) 410 3000; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins