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Abstract

Nosocomial infections are ubiquitous and Intensive Care Units (ICUs) are probably the most important focus of nosocomial infections in a hospital [1]. ICUs were described in 1971 by a hospital hygiene offiicer as the Mecca of microbes [2]. Today this statement can be considered even more appropriate considering that, although only 5-10% of all hospitalized patients are treated in ICUs, they account for approximately 25% of all nosocomial infections, and that the incidence of nosocomial infections in ICUs is 5-10 times higher than that observed in general hospital wards [3]. Moreover, ICUs are frequently reservoirs of highly resistant virulent microrganisms [4]. Some major risk factors for infection in ICUs have been identified [5] and may explain this situation. In fact, the normal host defence mechanisms of critically ill patients are often impaired by the use of devices (i.e. intravascular devices, endotracheal tubes, urinary catheterization) that have to be discontinued as soon as possible in order to reduce the incidence of infections. Furthermore, the normally low pH of the stomach is often neutralized by H2-blockers or antiacids, promoting the growth of enteric microrganisms [6].

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References

  1. Gauthier M (1993) Nosocomial infections in the pediatric intensive care unit: etiology and prevention. Crit Care Med 21[Suppl]:S315–S316

    Article  Google Scholar 

  2. Marget W, Daschner F (1971) Intensive care units: mecca for microbes. Fortschr Med 89: 895–896

    PubMed  CAS  Google Scholar 

  3. Widmer AF (1994) Infection control and prevention strategies in the ICU. Intensive Care Med 20:S7-S11

    Article  Google Scholar 

  4. Pierson CL, Friedman BA (1992) Comparison of susceptibility to ß-lactam antimicrobial agents among bacteria isolated from intensive care units. Diagn Microbiol Infect Dis 15: 19S-30S

    Article  Google Scholar 

  5. Vincent JL, Bihari DJ, Suter PM et al (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the EPIC study. JAMA 274:639–644

    Article  CAS  Google Scholar 

  6. ECC (1992) The First European Consensus Conference in Intensive Care Medicine: selective decontamination of the digestive tract in intensive care unit patients. Infect Control Hosp Epidemiol 13:609–611

    Article  Google Scholar 

  7. Spera RV Jr, Farber BF (1992) Multiply-resistant Enterococcus faecium. The nosocomial pathogen of the 1990s. JAMA 268:2563–2564

    Article  PubMed  Google Scholar 

  8. Panlilio AL, Culver DH, Gaynes RP et al (1992) Methicillin-resistant Staphylococcus aureus in US hospitals, 1975–1991. Infect Control Hosp Epidemiol 13:582–586

    Article  PubMed  CAS  Google Scholar 

  9. Shah PM (1991) Anti-infective therapy in intensive care units. Infection 19[Suppl]6:S316-S319

    Article  Google Scholar 

  10. Rello J, Ausina V, Ricart M et al (1994) Risk factors for infection by Pseudomonas aeruginosa in patients with ventilator-associated pneumonia. Intensive Care Med 20:193–198

    Article  PubMed  CAS  Google Scholar 

  11. Fish DN, Piscitelli SC, Danziger LH (1995) Development of resistance during antimicrobial therapy: a review of antibiotic classes and patient characteristics in 173 studies. Pharmacother 15:279–292

    CAS  Google Scholar 

  12. Nardi G, Valentinis U, Proietti A et al (1993) Epidemiological impact of prolonged systematic use of topical SDD on bacterial colonization of the tracheobronchial tree and antibiotic resistance. Intensive Care Med 19:273–278

    Article  PubMed  CAS  Google Scholar 

  13. Bonten MJM, Gaillard CA, Johanson WG Jr et al (1994) Colonization in patients receiving and not receiving topical antimicrobial prophylaxis. Am J Respir Crit Care Med 150: 1332–1340

    Article  PubMed  CAS  Google Scholar 

  14. Fiore AE, Joshi M, Caplan ES (1995) Approach to infection in the multiply traumatized patient. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, 4th ed Churchill Livingstone, New York, pp 2756–2760

    Google Scholar 

  15. Smith DJ Jr, Thomson PD (1992) Changing flora in bum and trauma units: historical perspective experience in the United States. J Bum Care Rehabil 13[Suppl 2]:276–280

    Article  Google Scholar 

  16. O’Brien TF (1986) Resistance to antibiotics at medical centers in different parts of the world. J Antimicrob Chemother 18[Suppl C]:243–253

    PubMed  Google Scholar 

  17. Lewis DA, Reeves DS (1994) Antibiotics at the extremes of age: choices and constraints. J Antimicrob Chemother 34[Suppl A] :11–18

    Article  PubMed  Google Scholar 

  18. Mulligan ME (1984) Epidemiology of Clostridium diiffffiicile-induced intestinal disease. Rev Infect Dis 6[Suppl 1]:S222-S228

    Article  Google Scholar 

  19. Davis R, Markham A, Balfour JA (1996) Ciprofloxacin: an updated review of its pharmacology, therapeutic efficacy and tolerability. Drugs 51:1019–1074

    Article  PubMed  CAS  Google Scholar 

  20. Bidwell Goetz M, Sayers J (1993) Nephrotoxicity of vancomycin and aminoglycoside therapy separately and in combination. J Antimicrob Chemother 32:325–334

    Article  Google Scholar 

  21. Moellering RC Jr (1995) Principles of anti-infective therapy. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, 4th ed Churchill Livingstone, New York, pp 199–212

    Google Scholar 

  22. Pagano A, Privitera G (eds) (1993) Indicazioni e limiti delle associazioni antibiotiche. In: Le infezioni ospedaliere — clinica e terapia. Intramed communications, Milano, pp 207–217

    Google Scholar 

  23. Jawetz E (1968) The use of combinations of antimicrobial drugs. Ann Rev Pharmacol 8: 151–170

    Article  PubMed  CAS  Google Scholar 

  24. Hess DA, Mahoney CD, Johnson PN et al (1990) Integration of clinical and administrative strategies to reduce expenditures for antimicrobial agents. Am J Hosp Pharm 47:585–591

    PubMed  CAS  Google Scholar 

  25. Pelletier LL Jr (1985) Hospital usage of parenteral antimicrobial agents: a graduated utilization review and cost containment program. Infect Control 6:226–230

    PubMed  Google Scholar 

  26. Polk RE (1987) The role of the infectious diseases physician in monitoring antimicrobial use: a pharmacy perspective. Bull NY Acad Med 63:612–626.

    CAS  Google Scholar 

  27. Sobel JD, Kaye D (1995) Urinary tract infections. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, 4th ed Churchill Livingstone, New York, pp 662–690

    Google Scholar 

  28. Levison ME, Bush LM (1995) Peritonitis and other intra-abdominal infections. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, 4th ed Churchill Livingstone, New York, pp 705–740

    Google Scholar 

  29. Allan JD, Moellering RC Jr (1985) Management of infections caused by gram-negative bacilli: the role of antimicrobial combinations. Rev Infect Dis 7[Suppl 4]:S559-S571

    Article  Google Scholar 

  30. Giamarellou H (1986) Aminoglycosides plus ß-lactams against gram-negative organisms. Evaluation of in vitro synergy and chemical interactions. Am J Med 80[Suppl 6B]:126–137

    Article  PubMed  CAS  Google Scholar 

  31. Milatovic D, Braveny I (1987) Development of resistance during antibiotic therapy. Eur J Clin Microbiol 6:234–244

    Article  PubMed  CAS  Google Scholar 

  32. Kibbler CC (1995) Neutropenic infections: strategies for empirical therapy. J Antimicrob Chemother 36[Suppl B]:107–117

    Article  PubMed  Google Scholar 

  33. Peloquin CA, Cumbo TJ, Nix DE et al (1989) Evaluation of intravenous ciprofloxacin in patients with nosocomial lower respiratory tract infections. Arch Intern Med 149:2269–2273

    Article  PubMed  CAS  Google Scholar 

  34. Yuen GJ, Drusano GL, Plaisance K et al (1989) Ciprofloxacin pharmacokinetics in critically ill trauma patients. Am J Med 87[Suppl 5A] :70S-75S

    Article  Google Scholar 

  35. Echols RM (1993) The selection of appropriate dosages for intravenous ciprofloxacin. J Antimicrob Chemother 31:783–787

    Article  PubMed  CAS  Google Scholar 

  36. Craig W (1993) Pharmacodynamics of antimicrobial agents as a basis for determining dosage regimens. Eur J Clin Microbiol Infect Dis 12[Suppl 1]:6–8

    Article  Google Scholar 

  37. Mac Kenzie FM, Gould IM (1993) The post-antibiotic effect. J Antimicrob Chemoter 32: 519–537

    Article  CAS  Google Scholar 

  38. Blaser J, Stone BB, Groner MC et al (1987) Comparative study with enoxacin and netilmicin in a pharmacodynamic model to determine importance of ratio of antibiotic peak concentration to MIC for bactericidal activity and emergence of resistance. Antimicrob Agents Chemother 31:1054–1060

    Article  PubMed  CAS  Google Scholar 

  39. Tulkens PM (1991) Efficacy and safety of aminoglycosides once-a-day: experimental and clinical data. Scand J Infect Dis [Suppl 74]:249–257

    Google Scholar 

  40. Begg EJ, Barclay ML (1995) Aminoglycosides — 50 years on. Br J Clin Pharmac 39:597–603

    Article  CAS  Google Scholar 

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© 1997 Springer-Verlag Italia

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Furlanut, M., Pea, F., Proietti, A. (1997). Guidelines on Antibiotic Combination in ICU Patients. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-2296-6_38

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  • DOI: https://doi.org/10.1007/978-88-470-2296-6_38

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-3-540-75032-1

  • Online ISBN: 978-88-470-2296-6

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