Antimicrobial resistance in the intensive care unit: the use of oral non-absorbable antimicrobials may prolong the antibiotic era

Antimicrobial resistance is a significant problem in the intensive care unit. Ill patients carry abnormal bacteria, amongst which are the causative organisms of many of the nosocomial infections. Overgrowth of these bacteria predisposes to infection. Further, the excretion of systemically administered antibiotics into the gut selects resistant bacteria from this population. In eliminating overgrowth, oral non-absorbable antibiotics prevent infections and prevent the development of antibacterial resistance. This paper discusses the limited effect of traditional approaches in preventing antibiotic resistance. These rely on restriction of classes of antibiotics used, or by restricting antibiotic use by more specific (often invasive) diagnostic techniques (such as protected brush specimens) for the diagnosis of pneumonia. In contrast we describe the experience of three centres using oral non-absorbable antibiotics finding that antibiotic resistance is not a significant clinical problem. In one 20-bed paediatric intensive care, admitting 1000 children per year, of 390 admissions who stayed more than four days 12 episodes of infection (in eight individuals) were caused by antibiotic resistant bacteria. Oral non-absorbable antibiotics prevent both infections and the emergence of antibiotic resistant bacteria.