ABSTRACT
Rapid identification of infected patients and accurate selection of antimicrobial agents for initial treatment of hospital-acquired pneumonia (HAP) are two key issues in the intensive care unit (ICU), since it appears that better treatment of this infection might have a major impact on hospital-associated mortality and morbidity.1, 2 On the contrary, use of empiric broad-spectrum antibiotics in patients without infection or with an infection caused by susceptible micro-organisms is potentially harmful, as it facilitates colonization and superinfection with multiresistant micro-organisms.3, 4 The results of many epidemiological investigations have clearly demonstrated a direct relationship between the use of antimicrobial agents and increased resistance of Enterobacteriaceae and other pathogens.4, 5 The indiscriminate use of antimicrobial agents in ICU patients may have immediate but also longterm consequences, contributing to the emergence of multiresistant pathogens and increasing the risk of severe superinfections. Therefore, it should be made clear to physicians confronted with ICU patients clinically suspected of having HAP that prescribing very broadspectrum antimicrobial agents to all these patients may lead to overtreatment of many of them and, thus, possibly to the rapid emergence of multiresistant pathogens, not only in the treated patients but also in other patients hospitalized in the same unit or elsewhere in the same hospital. Broad-spectrum empiric antibiotic therapy should, therefore, be accompanied by a commitment to de-escalate antibiotics, based on serial clinical and microbiologic data, in order to limit the emergence of resistance in the hospital.
