Abstract
Antibiotic resistance has emerged as a key determinant of outcome in patients with
serious infections along with the virulence of the underlying pathogen. Within the
intensive care unit (ICU) setting, ventilator-associated pneumonia (VAP) is a common
nosocomial infection that is frequently caused by multidrug-resistant bacteria. Antimicrobial
resistance is a growing challenge in the care of critically ill patients. Escalating
rates of antibiotic resistance add substantially to the morbidity, mortality, and
cost related to infection in the ICU. Both gram-positive organisms, such as methicillin-resistant
Staphylococcus aureus and vancomycin-intermediate S. aureus, and gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter species, carbapenem-resistant Enterobacteriaceae, such as the Klebsiella pneumoniae carbapenemase–producing bacteria, and extended spectrum β-lactamase organisms, have
contributed to the escalating rates of resistance seen in VAP and other nosocomial
infections. The rising rates of antimicrobial resistance have led to the routine empiric
administration of broad-spectrum antibiotics even when bacterial infection is not
documented. Moreover, there are several new broader-spectrum antibiotics that have
recently become available and others scheduled for approval in the near future. The
challenge to ICU clinicians is how to most effectively utilize these agents to maximize
patient benefits while minimizing further emergence of resistance. Use of rapid diagnostics
may hold the key for achieving this important balance. There is an urgent need for
integrating the administration of new and existing antibiotics with the emerging rapid
diagnostic technologies in a way that is both cost-effective and sustainable for the
long run.
Keywords
rapid diagnostics - antibiotic resistance - microbiology - outcomes
