Management of Multidrug-Resistant Infections in ICUs: A Narrative Review of Pharmacological and Non-pharmacological Interventions
Abstract
Multidrug-resistant (MDR) infections in ICUs are a growing global health challenge associated with increased morbidity, mortality, prolonged hospitalization, and rising healthcare costs. Critically ill patients are particularly vulnerable because of immune dysfunction, invasive procedures, prolonged ICU stays, and frequent exposure to broad-spectrum antibiotics, all of which increase susceptibility to MDR infections and antimicrobial selection pressure. Common MDR pathogens in ICU settings include Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and carbapenem-resistant Enterobacterales. Major resistance mechanisms include β-lactamase and carbapenemase production, efflux pump overexpression, reduced membrane permeability, target modification, biofilm formation, and horizontal gene transfer. Effective management of MDR infections in ICUs requires an integrated, evidence-based approach combining early recognition, microbiological diagnosis, optimized antimicrobial therapy, and strict infection-prevention strategies. Pharmacological management relies on appropriate empiric therapy, antimicrobial stewardship, therapeutic drug monitoring, and pharmacokinetic/pharmacodynamic optimization to improve treatment efficacy while minimizing toxicity and resistance development. Newer antimicrobial agents, including β-lactam/β-lactamase inhibitor combinations and cefiderocol,…
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