Threat in ICU in 2014; emerging resistance in Gram negatives.

Emerging antibiotic resistance mechanisms are emerging now worldwide at a high rate in particularly among nosocomial infections. The perspective of impossible-to-treat infections is raising due to lack of perspective of the development of effective novel antibiotics. This may cancel the developments of the modern medicine such as important surgery, transplantation and intensive care.

Multidrug resistance and pandrug resistant strains are increasingly identified in species such as Klebsiella pneumoniae; Escherichia coli, Pseudomonas aeruginosa and Acinetobacter baumannii which are the main Gram-negative pathogens in ICU. The most important resistant traits are the extended-spectrum ß-lactamases and the carbapenemases that hydrolyse at least the expanded-spectrum cephalosporins and the carbapenems, respectively. Those resistance traits are mostly associated to resistance markers to fluoroquinolones and aminoglycosides which are the two other main antibiotic classes of broad spectrum activity. Those emerging resistance traits are mostly the results of overuse and misuse of antibiotics in developing countries in human medicine followed by transfer of multidrug resistant bacteria by humans themselves (travel, migration..). Screening of infected patients and carriers by using rapid diagnostic techniques is becoming mandatory for choosing the most appropriate first line antibiotherapy and preventing the development of outbreaks.