At least 80 per cent of patients receive antibiotic treatment during a stay in the intensive care unit (ICU), and the choice of antibiotic for empirical use can have a dramatic effect on the species and susceptibilities of the pathogens causing nosocomial infections. Ampicillin and imipenem are effective inducers of b-lactamase in Gram-negative bacteria. Substitution of ampicillin with cefuroxime results in a dramatic fall in the ampicillin resistance of Gram-negative isolates and a reduction in Klebsiella infections. However, the widespread use of cephalosporins has in turn been linked to the emergence of enterococci as major pathogens because of their general resistance to these agents.

Antibiotic treatment must aim to be rational, effective, and safe while posing the minimum threat of selection of bacterial resistance and remaining economical (Geddes J 988). The majority of infections in the ICU are hospital acquired and many are treated empirically. A policy should be decided for both treatment and prophylaxis of infection based on the common pathogens and their current antibiotic sensitivity patterns. The policy should be flexible and revised whenever indicated by a change in the properties of organisms causing bacteremia or serious infections. Therefore close liaison with the microbiologist and/or infectious disease physician is necessary.

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