Antibiotic resistance in the intensive care unit : A primer in bacteriology

The clinical use of potent, well-tolerated, broad-spectrum antibiotics has been paralleled by the development of resistance in bacteria, and the prevalence of highly resistant bacteria in some intensive care units is despairingly commonplace. The intensive care community faces the realistic prospect...

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Bibliographic Details
Published in:Anaesthesia and intensive care 2005-04, Vol.33 (2), p.188-195
Main Authors: IREDELL, J, LIPMAN, J
Format: Article
Language:English
Subjects:
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Bacteriophages - physiology
Biological and medical sciences
Drug Resistance, Bacterial - genetics
Genome, Bacterial
Humans
Integrons - genetics
Integrons - physiology
Intensive Care Units
Medical sciences
Plasmids - genetics
Plasmids - physiology
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Summary:The clinical use of potent, well-tolerated, broad-spectrum antibiotics has been paralleled by the development of resistance in bacteria, and the prevalence of highly resistant bacteria in some intensive care units is despairingly commonplace. The intensive care community faces the realistic prospect of untreatable nosocomial infections and should be searching for new approaches to diagnose and manage resistant bacteria. In this review, we discuss some of the relevant underlying biology, with a particular focus on genetic transfer vehicles and the relationship of selection pressure to their movements. It is an attempt to demystify the relevant language and concepts for the anaesthetist and intensivist, to explain some of the reasons for the emergence of resistance in bacteria, and to provide a contextual basis for discussion of management approaches such as selective decontamination and antibiotic cycling.
ISSN:0310-057X
1448-0271
DOI:10.1177/0310057X0503300206