Development of Resistance against Antimicrobial Agents in the Intensive-Care Unit

Despite alarming reports about rising bacterial resistance rates against antimicrobial agents, it has to be stated that in Switzerland most bacteria are still susceptible to many antimicrobials. Even in intensive care units, resistance problems concentrate – at least for the time being – in few patients and/or temporarily in an ICU. However, preventive action by applying hygiene measures and by using antimicrobial agents restrictively has to be taken already now. The situation has to be monitored carefully to prevent spread of resistant bacteria. Of concern are especially the following: gram-negative bacteria producing β-lactamases capable of destroying a wide array of β-lactam antibiotics or having a reduced uptake of carbapenems and quinolones due to altered membrane proteins; enterococci resistant against glycopeptides or having high resistance against aminoglycosides resulting in lack of synergism with penicillins; the increaseing number of pneumococci resistant against penicillin and macrolides; and methicillin-resistant Staphylococcus aureus.