10.1177/0897190004273593PATEL AND CRANKGRAM-NEGATIVE RESISTANCE IN THE ICU Gram-Negative Resistance in the Intensive Care Unit

Gram-negative resistance is an increasingly important con-sideration when initiating empiric antimicrobial therapy in intensive care units. Infection with a resistant organism has been associated with increased morbidity and mortality as well as increased hospital cost. Gram-negative resistance in intensive care units will likely continue to increase. Clini-cians must aggressively manage infections in the intensive care unit while practicing the appropriate steps to minimize future resistance. This review article summarizes the epide-miology, risk factors, mechanisms of resistance, and management of infections due to resistant gram-negative organisms. KEY WORDS: Gram-negative, resistance, intensive care unit, antimicrobial, mechanism. GRAM-NEGATIVE RESISTANCE is an increas-ingly important consideration when initiating empiric antimicrobial therapy in intensive care units (ICUs). Infection with a resistant organism has been as-sociated with increased morbidity and mortality as well as increased hospital cost.1 In 2001, the SENTRY Antimicrobial Surveillance Program recorded data from 25 ICUs on 1321 isolates from bloodstream, respi-ratory tract, urinary tract, and wound infections.2 Pseudomonas aeruginosa was the most common gram-negative organism isolated from the SENTRY data, accounting for 12.2 % of bacteria isolated from the ICUs. P aeruginosa was followed in frequency by Esch-erichia coli (10.1%), Klebsiella species (8.9%), an