From Colonisation to Infection by Multi-Antibiotic Resistant Bacteria: Identifying and Managing the Risk in Patients Admitted to the Intensive Care Unit*

Abstract

The treatment of infections related to multidrug resistant bacteria is a major issue in the intensive care unit. Colonization due to endogenous or exogenous bacteria represents a first step before infection in critically ill patients, in whom immunosuppression and invasive devices are common. The occurrence of infection depends on the relationship between host and bacteria, and is favored by the quantity of multidrug resistant pathogens after a modification of the gut microbiota. Strategies for the prevention of healthcare-associated infections should include the reduction of colonization pressure, by measures aiming at reducing cross-transmission of multidrug resistant bacteria, and the reduction of selection pressure by reducing antimicrobial treatment. Decolonization may be an interesting complementary method for critically ill patients, and should be used as a part of a global approach including the above-cited strategies.