ICU Management & Practice, Volume 19 - Issue 1, 2019

Trends in epidemiology and antimicrobial resistance in intensive care units

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The intensive care unit has a unique environment, mainly because it treats severe and critically ill patients who require special care. Critical care patients often require high-risk surgeries, and there is also a frequent need for invasive devices such as central or peripheral venous catheters, urinary catheters or tracheal tubes, among others. This makes these patients more susceptible to hospital-acquired infections (HAIs).


Recent data from the European Union (EU) reports that patients admitted to an ICU for more than 2 days acquired at least one HAI. These HAIs included cases of pneumonia, bloodstream infections, and urinary tract infections.


HAIs cause increased morbidity and higher treatment costs. It is estimated that HAIs result in nearly 15 million additional days of hospitalisation. More than €5.5 billion per year is spent because of HAIs. But what is even more worrisome is the fact that HAIs in an ICU environment can be life-threatening. In the EU, over 37,000 deaths each year are attributed to HAIs, and most of these deaths involve ICU patients.


Antibiotics play an important role in managing HAIs, but the problem of antibiotic resistance continues to be an issue in ICUs. Most HAIs that originate in the ICU are caused by multidrug-resistant microorganisms. The most frequent pathogens that reside in the ICU include Escherichia coli and members of the ESKAPE group (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.). Each of these microorganisms is resistant to most antibacterial agents that are commonly used in the ICUs.


The ESKAPE group, in particular, deserves special attention because of their virulence power and the fact that they have a higher level of antibiotic resistance. These pathogens are associated with high mortality rates in critically ill patients and are thus a major threat to public health.


In short, antimicrobial resistance is an area of concern. There are fears that we might be returning to a pre-antibiotic era when untreatable pan-resistant microorganisms would colonise the ICU. Antibiotic options to treat the main pathogens that cause HAI have become scarce. No further development seems to be in sight since pharmaceutical companies have already announced that they are no longer investing in the development of new antibiotic drugs. Thus, the presence of highly resistant microorganisms that cause HAI is a reality that needs to be addressed.


The problem of antibiotic resistance did not occur overnight. This resistance is related to several factors including the misuse and overprescribing of antibacterial agents as well as premature treatment stops and incorrect dosages. Statistics show that in the EU from 2011-2012, hospitalised patients who received at least one antibiotic during their stay was 35% increasing to 56.5% among patients admitted to an ICU. This in itself demonstrates that there is an enhanced pressure within the ICU to prescribe antibiotics and this practice contributes to the development of antibiotic resistance.


There is a need to take urgent action to halt or mitigate the development of antibiotic resistance. Strict antibiotic control measures must be implemented in all hospital settings, especially in the ICUs. In addition, the development of new treatment alternatives to tackle these microorganisms should remain a research priority.


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Pons, MJ and Ruiz J (2019) Current trends in epidemiology and antimicrobial resistance in intensive care units. Journal of Emergency and Critical Care Medicine, 3:5.

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