ABSTRACT
Results from the European Prevalence of Infection in Intensive Care (EPIC) study showed that 21% of patients had at least one infection acquired in a critical care unit. The major types of infection were pneumonia (47%), other lower respiratory tract infections (LRTI, 18%), urinary tract infection (UTI, 18%) and bacteraemia (12%), reflecting the difference from infection acquired on the ward where UTI predominates. This study also showed the increasing importance of Gram-positive bacteria in these infections (e.g. Staphylococcus aureus, coagulase-negative staphylococci and enterococci), which are often multi-resistant. The classic nosocomial pathogens such as Pseudomonas and Acinetobacter species still remain major problems on critical care units. They have a propensity to survive and transfer in this environment and have an innate resistance to antibiotics. There has been an emergence of Gram-negative bacteria which produce extended-spectrum beta-lactamase (ESBL) (e.g. Klebsielleae and Escherichia coli). This is of concern, because ESBL confers resistance to most beta-lactams, including the newer cephalosporins. The use of broad-spectrum antibiotics accounts also for the increasing number of fungal infections on critical care units.
