The intensive care unit is usually the hot zone of antibiotic resistance in a hospital. Reports of outbreaks of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Enterobacter aerogenes, Stenotrophomonas maltophilia, and Pseudomonas aeruginosa in intensive care units are reviewed. Despite infection control measures bordering on the heroic, including cohorting, contact isolation, intensive microbiologic surveillance with molecular subtyping and re-emphasis of handwashing, these measures were only marginally successful. We cite Farr's Law of Epidemics in suggesting that, over time, the efficacy of infection control measures may be overrated. Innovative measures in prevention of ventilator associated pneumonia continue to be contentious. The efficacy of sulcralfate, antacids, and histamine blockers remain uncertain despite numerous controlled studies. Likewise, most studies (but not all) show that selective digestive decontamination can decrease the incidence of ventilator associated pneumonia, but mortality remains unaffected.
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