Antibiotic use and antibiotic resistance in the intensive care unit: are we curing or creating disease?

Antibiotics represent one of the most commonly prescribed medical therapies for hospitalized patients. The practice of "spiralling empiricism" has increasingly led to the unnecessary administration of antibiotics, resulting in the emergence of infections with antibiotic-resistant bacteria that are associated with increased rates of patient mortality. Ventilator-associated pneumonia due to antibiotic-resistant bacteria has become recognized as an important problem resulting from prior antibiotic exposure. Health professionals must be aware of this problem and avoid the unnecessary administration of these drugs. Future research efforts should be aimed at improving our ability to diagnose and exclude infections and to develop better strategies for antibiotic administration in the intensive care unit setting.