Antimicrobial Use in Surgical Intensive Care

Intensive care has evolved over its 50-year history to yield previously unimaginable recovery from major trauma, multi-organ system failure, and extensive surgery, including organ transplantation. Antimicrobial therapy plays an essential role in combating invasive infections in the intensive care population that are often the ultimate causes of death. However, a parallel evolution of antimicrobial compensation has occurred, engendering resistance and virulence mechanisms to circumvent each new antimicrobial agent. The surgical intensive care unit provides the ultimate microcosm of antimicrobial resistance selection, combining complex and severe underlying illness with invasive devices, bypassed defenses, compromised tissues, and proximity to other high-risk patients, all in one intimate environment. New resistance mechanisms may be introduced from referring institutions or can emerge in response to treatments, and then may spread to others within or outside the ICU. Multidrug-resistant organisms have become a dominant issue in modern health care; a strategic response is essential to short- and long-term success.