January 26, 2018
Since 2001 the use of antibiotics in intensive care units in Germany has increased by 19%. This is a result of a cohort study that was initiated at that time: the SARI study ("Surveillance der Antibiotika-Anwendung und der bakteriellen Resistenzen auf deutschen Intensivstationen"—surveillance of antibiotic use and resistance in intensive care units) is the subject of an article in this week's issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2017; 114: 858-65). The 77 participating intensive care units also reported an increase in the resistance density of gram-negative multiresistant pathogens for the period 2001 to 2015; Remscheid and coauthors regard in particular the rise in pathogens with resistance to imipenem as cause for grave concern. They think it is plausible that the increased use of broad-spectrum and reserve antibiotics has facilitated this trend.
The authors take the view that the serious increase in resistant pathogens should prompt a strengthening in the national attention to this problem and result in the support and implementation of relevant preventive measures. In this context, rapid diagnostic evaluation and targeted therapy, but also effective measures to prevent the spread of multiresistant pathogens are of crucial importance, they say. At least in all hospitals with intensive care units, specialists in "antibiotic stewardship" and infection prevention should be employed on a regular basis. The increase in the use of broad-spectrum and reserve antibiotics should prompt the optimization of rational antibiotic use in hospitals by ensuring the necessary structural and staffing requirements.