Objective: To assemble the available clinical data on the prevention of antimicrobial resistance
in the intensive care unit (ICU) setting.
Data Source: A MEDLINE database search and references from identified articles were employed
to obtain the literature relating to the prevention of antimicrobial resistance in the ICU.
Conclusions: The ICU presents a unique environment for the conduct of clinical research.
The closed physical space with centralized patient management and efficient data recovery
allows important clinical questions to be evaluated in a timely manner. Antimicrobial resistance
has emerged as an important determinant of mortality for patients in the ICU. Additionally,
there is currently a limited pipeline of new agents for the treatment of emerging bacteria
with new resistance genes that pose an increasing threat to the ICU patient. Effective
strategies for the prevention of antimicrobial resistance within ICUs are available and should
be implemented aggressively. These strategies can be divided into non-pharmacologic infection-
control strategies (e.g., routine hand hygiene, infection-specific prevention protocols) and
antibiotic management strategies (e.g., shorter courses of appropriate antibiotics, narrowing
of the antimicrobial spectrum on the basis of culture results). Additional studies conducted
in ICUs are needed urgently to identify the optimal approaches for the management of antibiotics
in order to balance the need for efficacy with the ability to minimize resistance.
