ARE INTENSIVE CARE UNITS (ICU’s) A THREAT TO LIFE?

1. ARE INTENSIVE CARE UNITS (ICU’s) A THREAT TO LIFE?
Dr.T.V.Rao MD
Misuse of Antibiotics and Consequences Antibiotics have saved countless lives
in the last 80 years, but they're not as effective as they once were. We use too
many of them, and so bacteria are developing resistance more quickly than we
can come up with new drugs. The result is a growing spate of untreatable
infections, The misuse of antibiotics in both developed and developing
countries has begun to diminish the potency of these valuable drugs,
prompting calls for an international response. I teach my students the great
reasons for population explosion is the great advances in Antibiotics, saving
lives which should have perished with even simple Staphylococcal infections.
Today many researchers say 1 in 6 people put on Antibiotics die for many
preventable reasons and Antibiotic too contribute to the terminal events. In
the U.S. alone, 23,000 people die from "super bugs" each year, according to
the Centers for Disease Control and Prevention, Penicillin was the cheapest
substance which has changed the future of medicine, no so with many newer
antibiotics some of them are more expensive even the Gold Antibiotics are less
lucrative than other kinds of drugs," says Allan Coukell, an antibiotics expert at
the Pew Charitable Trusts. "They've historically been cheap and a new
antibiotic is often competing against something that's been around a long time
and is off-patent." Pharmaceutical companies don't want to make new
antibiotics and academics don't want to research them. Something needs to
change. United States we cherish with many principles of life and science
violates the many human concerns three problems with the US food supply
that is making food a source of disease rather than optimal health include: the
way our food is raised; the way it's processed; and the routine use of
hazardous drugs and chemicals. The United States is one of the few countries
in the world that produces and processes food in a way that defies both
science and common sense. Perhaps one of the most objectionable of US food
practices is the routine use of antibiotics in livestock for growth-promoting
purposes. Agriculture accounts for about 80 percent of all antibiotics used in
the US, so it's a primary source of antibiotic exposure, and it's the continuous
use of low dose antibiotics that permits bacteria to survive and become
increasingly hardy and drug resistant. A brand new report commissioned by UK
Prime Minister, David Cameron, estimates that by 2050 antibiotic resistance
will have killed 300 million people; the annual global death toll reaching 10

2. million. We almost moved from most narrow spectrum antibiotics like
Penicillin’s to new generation of Broad spectrum of antibiotics When you take
a broad-spectrum antibiotic, which is the kind most commonly prescribed
antibiotic , if we analyse most prescription contain 3 rd generation
Cephalosporins it may be that rare microbes occasionally get wiped out
entirely. And once the population hits zero, there is no bouncing back. For our
body, that species is now extinct. My worry is that some of these critical
residential organisms -- what I consider "contingency" species -- may disappear
altogether. If you feel for yourself what are the dynamic changes happening in
Intestinal tract with the consumption of any Newer antibiotics. With repeated
use of Antibiotics the dynamics of the human Microbiota alter and change our
diverse microbes, with their millions of genes helping us resist disease, are the
guerrilla warriors defending the home domain -- as long as we protect them.
But recent studies suggest that otherwise normal people already have lost 15%
to 40% of their microbial diversity and the genes that accompany it. We must
understand that every antibiotic course has a biological cost, and more
precisely align possible benefit with the full costs.. Try visiting an ICU majority
are with most resistant Bactria Visit a large hospital in any Town in our
country: a growing number of infections of the urinary, intestinal, or
respiratory tract or bloodstream with microbes that are resistant to the most
common antibiotics. In community settings, resistant bacteria are increasingly
causing diarrhoea, pneumonia, and even tuberculosis.
Intensive care units (ICUs) are generally considered epicentres of antibiotic
resistance and the principal sources of outbreaks of multi-resistant bacteria.
The most important risk factors are obvious, such as excessive consumption of
antibiotics exerting selective pressure on bacteria, the frequent use of invasive
devices and relative density of a susceptible patient population with severe
underlying diseases. Infections due to antibiotic-resistant bacteria have a
major impact on morbidity and health-care costs, A quality control of
antimicrobial therapy within a hospital, and especially within the ICU, might
help to minimize the selection of multidrug-resistant bacteria .ICU,s continues
to be threat to the patient who live in there but to many surrounding, The
professionals associated with critical car medicine should realise, ICUs are an
important area for the emergence of antimicrobial resistance due to the
frequent use of broad-spectrum antibiotics; the crowding of patients with high
levels of disease acuity within relatively small specialized areas; reductions in
nursing staff and other support staff due to economic pressures, which

3. increase the likelihood of person-to-person transmission of microorganisms;
and the presence of more chronically and acutely ill patients who require
prolonged hospitalizations and often harbour antibiotic-resistant bacteria. .
Technology already provides important tools to improve doctors' judgments
about when antibiotics are needed, but we must get them into the clinical
practice and action. We also must develop new tools, like "narrow-spectrum"
antibiotics that target only the invader and minimize collateral effects.
† Practical measures
As discussed, the development of antimicrobial resistance in an intensive care
setting has multiple causes. Strategies to counter these include:
† New admissions to ICU should be screened for target organisms and
wherever possible isolated to prevent the introduction of resistant strains.
Strict infection control measures including isolation, hand washing, and
minimizing the number of nursing and medical staff involved in each patients’
care.
† Regular surveillance of the local micro flora and resistance patterns occurring
within the ICU should be performed, leading to regular review of empirical
antibiotic guidelines.
† Before administration of antibiotics, sufficient cultures should be sent to
facilitate microbiological identification. Bronchoscopy should be considered if
pneumonia is suspected to enable better sputum samples to be sent and
improve microbiological isolation.
† Prescriptions should be reviewed after 2– 3 days. Antibiotic therapy may
then be altered according to sensitivity information, or stopped altogether if
no organisms have been isolated and the clinical picture allows it.
† Oversight of antibiotic prescriptions by ICU pharmacists and Microbiologists
may prevent inadequate dosing regimens and reduce inappropriate
prescriptions.
Ref Strategies to Prevent Antimicrobial Resistance in the Intensive Care
UnitMarin H. Kollef, MD; Scott T. Micek, PharmD; R Phillip Dellinger, MD,
Critical Care Medicine Medscape
2 † Antibiotic resistance in the intensive care unitAJ Varley BSc MRCS FRCAH
Williams MB BCh FRCPath S Fletcher FRCA FRCPE

4. WELL SAID AND NEVER OR LEAST FOLLOWED ARE SIMPLE
MEASURES LIKE EVEN HAND WASHING WILL COST MANY LIVES IN
INTENSIVE CARE UNITS, HOWEVER THE SUCCESS OF ANY
MUTISPECALITY AND TERMINALS CARE HOSPITALS REMAIN WITH
REDUCTION OF HOSPITAL ASSOCIATED INFECTIONS,
Dr.T.V.Rao MD Professor of Microbiology Freelance writer