Antibiotic Resistance in ICUs: A Multifaceted Problem Requiring a Multifaceted Solution

Antibiotics are a remarkable class of drugs and have had a major impact on public health.1 Early in this century, infectious diseases were among the most common causes of death. Deaths from these diseases have since decreased dramatically in the US population, largely because of antibiotics. Unfortunately, some of these same diseases are reemerging, largely because the agents that cause them have developed resistance to antibiotics.2 Controlling antibiotic resistance is exceedingly important. Newer agents are almost always more costly. If resistance has occurred to the drug of choice, alternative choices often are more toxic, eg, antituberculous agents. However, we are now faced with the loss of efficacy of antibiotics-something we have not really faced since their introduction as a class of drugs. Multidrug-resistant tuberculosis and vancomycin-resistant enterococci (VRE) have become essentially untreatable in a large percentage of cases.3 What is the way out of this pressing problem? We no longer can rely on pharmaceutical companies to bail us out of this predicament. Antibiotic drug discovery waned in the late 1980s. Bringing a new drug to market is an enormous expense-one that has to be profitable for the company.4 From a business standpoint, money spent on antibiotic drug discovery might be better spent on other classes of pharmaceuticals. Think about it. What other class of new drugs loses efficacy the moment the drugs are released for widescale use? Signs are developing that the industry has increased their antibiotic discovery efforts, in some cases dramatically, but we are years away from seeing the fruits of these labors. Indeed, drug companies cannot guarantee they will find a new class of antibiotics to heal what ails our patients. Since the introduction of quinolones in the 1980s, no new class of antibiotics has been introduced. Recent reports have shown that resistance to quinolones occurred with alarming swiftness.5,6 The problem of antibiotic resistance in hospitals cannot be solved solely by the repetitive introduction of new antibiotics. That strategy would be too costly and ultimately would fail.