“Does this patient have…” “Is this patient at risk for infection with multidrug resistant bacteria?”

Excerpt

A 67-year-old woman with insulin-dependent diabetes and end-stage renal disease receiving outpatient hemodialysis has been hospitalized twice over the past 10 weeks with acute pneumonia and respiratory failure. Given her prior hospitalizations with antibiotic exposure, this patient would appear to be at increased risk for infection with potentially antibiotic-resistant bacteria. Antibiotic resistance has emerged as one of the most important determinants of outcome in patients with serious infections along with the virulence of the underlying pathogen. 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 costs of infections in the ICU setting [1]. Both Gram-positive organisms, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), and Gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter species, and Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria have contributed to the escalating rates of multidrug resistant (MDR) bacteria accounting for infections in the ICU. …