Epidemiology of nosocomial infections in adult intensive care units.

Patients in intensive care units (ICUs) are a small subgroup of all hospitalized patients, but they account for approximately 25% of all hospital infections. Nosocomial infection rates among ICU patients are 5-10 times higher than among general ward patients. ICU infection rates are higher due to complex interactions between the patients' underlying disease, severity of illness, type of ICU, duration of stay, and invasive devices used. Antimicrobial resistance is a major clinical problem despite potent and newer antibiotics. Organisms that pose a clinically significant resistance problem among ICU patients include methicillin-resistant staphylococci, enterococci, a wide variety of enterobacteriaceae, Pseudomonas aeruginosa, Pseudomonas cepacia, Xanthomonas maltophila, Acinetobacter and Candida species. Traditional infection control measures include identification of reservoirs, halting transmission between patients, stopping progression from colonization to infection and modifying host risk. In addition, sound selection procedures and guidelines for antibiotic usage are necessary to control the spread of multi-resistant micro-organisms.