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Håkan Hanberger, MD, PhD; José-Angel Garcia-Rodriguez, MD, PhD; Miguel Gobernado, MD, PhD; Herman Goossens, MD, PhD; Lennart E. Nilsson, PhD; Marc J. Struelens, MD, PhD; and the French and Portuguese ICU Study Groups

JAMA. 1999;281:67-71.

Context  Surveillance of antibiotic resistance is especially important in intensive care units (ICUs) because the infection rates are much higher there than in other hospital wards and most epidemics with multiresistant bacteria originate in ICUs.

Objective  To evaluate the incidence of decreased antibiotic susceptibility among aerobic gram-negative bacilli isolated from patients in ICUs.

Design  Consecutive specimens collected on clinical indications from ICU patients were cultured and tested. Minimum inhibitory concentrations for amikacin, ceftazidime, ceftriaxone, ciprofloxacin, gentamicin, imipenem, piperacillin, and piperacillin-tazobactam were determined using E test.

Setting  Eighteen hospitals in Belgium, 40 in France, 20 in Portugal, 30 in Spain, and 10 in Sweden.

Subjects  A total of 9166 gram-negative strains were initially isolated from 7308 patients between June 1994 and June 1995.

Main Outcome Measures  The incidence of decreased susceptibility, defined as the sum of resistant and intermediate categories with use of the minimum inhibitory concentration break points recommended by the National Committee for Clinical Laboratory Standards.

Results  The most frequently isolated organisms were Enterobacteriaceae (59\%) followed by Pseudomonas aeruginosa (24\%). The main sources were respiratory tract (42\%), urine (26\%), blood (14\%), abdomen (11\%), and skin and soft tissue (7\%). Decreased antibiotic susceptibility across all species and drugs was highest in Portuguese ICUs followed by French, Spanish, Belgian, and Swedish ICUs. The highest incidence of resistance was seen in all countries among P aeruginosa (up to 37\% resistant to ciprofloxacin in Portuguese ICUs and 46\% resistant to gentamicin in French ICUs), Enterobacter species, Acinetobacter species, and Stenotrophomonas maltophilia, and in Portugal and France among Klebsiella species.

Conclusion  The high incidence of reduced antibiotic susceptibility among gram-negative bacteria in these ICUs suggests that more effective strategies are needed to control the selection and spread of resistant organisms.

Author Affiliations: Departments of Infectious Diseases (Dr Hanberger) and Clinical Microbiology (Dr Nilsson), University Hospital, Linköping, Sweden; and the Department of Microbiology, University Hospital, Salamanca, Spain (Dr Garcia-Rodriguez); Department of Microbiology, Hospital Le Fe, Valencia, Spain (Dr Gobernado); Department of Microbiology, University Hospital, Antwerp, Belgium (Dr Goossens); and Department of Microbiology, University of Brussels Hospital Erasme, Brussels, Belgium (Dr Struelens). A complete list of the members of the ICU Study Groups appears at the end of this article.

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