Infection in the intensive care unit (ICU)

ESBLs: A Clear and Present Danger?

Extended spectrum β-lactamases (ESBLs) are enzymes produced by a variety of Gram negative bacteria which confer an increased resistance to commonly used antibiotics. They are a worrying global public health issue as infections caused by such enzyme-producing organisms are associated with a higher morbidity and mortality and greater fiscal burden. Coupled with increasing prevalence rates worldwide and an ever diminishing supply in the antibiotic armamentarium, these enzymes represent a clear and present danger to public health. This article aims to give an overview of the current situation regarding ESBLs, with a focus on the epidemiology and management of such infections.

Bacterial resistance and mortality in an intensive care unit

The goal was to identify risk factors for healthcare-associated infections by resistant microorganisms and patient mortality in an Intensive Care Unit. A prospective and descriptive epidemiological research was conducted from 2005 till 2008, involving 2300 patients. Descriptive statistics, bivariate and multivariate logistic regression analysis were used. In bivariate analysis, infection caused by resistant microorganism was significantly associated to patients with community-acquired infection (p=0.03; OR=1.79) and colonization by resistant microorganism (p<0.01; OR=14.22). In multivariate analysis, clinical severity (p=0.03; OR=0.25) and colonization by resistant microorganism (p<0.01; OR=21.73) were significant. Mortality was associated to the following risk factors: type of patient, average severity index, besides mechanical ventilation. The relation between resistant microorganisms and death shows the need to monitor adherence to infection control measures so as to improve care quality and mainly survival of critical patients.