Screening of ICU patients for antibiotic resistance

Dr Mark Loeb is a professor in the Department of Pathology and Molecular Medicine, division director for Infectious Diseases, and Michael G. DeGroote Chair in Infectious Diseases at McMaster University.

Should we screen patients admitted to the intensive care unit (ICU) for antibiotic resistance? Which resistant pathogens should we screen for?

Mark Loeb, MD, MSc: You have to know what the epidemiology of the resistance pattern is in your ICU. It is very variable. In some ICUs you might be screening for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), in others for extended-spectrum beta-lactamase (ESBL)-producing strains, in others for carbapenem-resistant gram-negatives or Enterobacteriaceae.

There is not really one answer for that question. The real answer is to actually know the epidemiology of the resistant organisms in your ICU and then you screen appropriately for that, depending on what the local epidemiology is.