Framework of Antimicrobial Resistance in the ICU: Risk Factors, Pathogenesis, Prevention, and Clinical Pharmacist Interventions

Author

V.V. Sathyaseelan, R. Swaathi and G.R. Haripriya


Abstract

 Antimicrobial resistance (AMR) is a major global public health problem and is particularly challenging in the Intensive Care Unit (ICU), where critically ill patients are highly susceptible to severe infections. The frequent use of broad-spectrum antibiotics, invasive medical devices, prolonged hospital stays, and immunocompromised conditions contribute to the emergence and spread of multidrug-resistant (MDR) pathogens. Common resistant organisms in ICUs include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, carbapenem-resistant Enterobacterales (CRE), multidrug-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii. AMR leads to treatment failure, prolonged ICU stay, increased healthcare costs, higher mortality, and limited therapeutic options. Effective management requires antimicrobial stewardship, infection prevention and control measures, rapid diagnostic techniques, and optimization of antimicrobial therapy. Clinical pharmacists play a vital role in promoting the appropriate use of antibiotics through dose optimization, therapeutic drug monitoring, antimicrobial de-escalation, intravenous-to-oral switch therapy, and education of healthcare professionals. This review summarizes the risk factors, mechanisms, common resistant pathogens, clinical consequences, prevention strategies, and the role of the clinical pharmacist in combating antimicrobial resistance in the ICU. A multidisciplinary approach is essential to preserve antibiotic effectiveness, improve patient outcomes, and reduce the global burden of antimicrobial resistance.



Keywords

antimicrobial resistance; intensive care unit; multidrug-resistant organisms; antimicrobial stewardship; clinical pharmacist; critical care



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References


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