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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Think (Gram) negative! | Huttner and Harbarth Critical Care 2010 14 171 http ccforum.eom content 14 3 171 CRITICAL CARE COMMENTARY L__ Think Gram negative Benedikt Huttner and Stephan Harbarth See related research by Meyer etal. http ccforum.eom content 14 3 R113 Abstract The increasing prevalence of multiresistant Gramnegative bacteria of the Enterobacteriaceae family in Europe is a worrisome phenomenon. Extended-spectrum betalactamase-producing Escherichia coli strains are widespread in the community and are frequently imported into the hospital. Of even more concern is the spread of carbapenem-resistant strains of Klebsiella spp. from regions where they are already endemic. Antibiotic use is a main driver of antibiotic resistance which again increases broad spectrum antibiotic use resulting in a vicious circle that is difficult to interrupt. The present commentary highlights important findings of a surveillance study of antimicrobial use and resistance in German ICUs over 8 years with a focus on Gram-negative resistance. In a recent issue of Critical Care Meyer and colleagues 1 report interesting surveillance data from ICUs in 30 German hospitals based on a large amount of microbiology and pharmacy data gathered between 2001 and 2008. One of the main study findings is a decreasing rate of methicillin-resistant Staphylococcus aureus MRSA and a dramatic increase of third generation cephalosporin 3GC resistant Enterobacteriaceae over the study period. In recent years most European countries have succeeded in reducing the burden of disease caused by MRSA 2 3 .This progress has however been partly offset by the increase across Europe in the prevalence of multiresistant Gram-negative pathogens producing extended-spectrum betalactamases ESBLs or carbapenemases 4 . The current study confirms this worrisome finding and also shows an increase in carbapenem 3GC and fluoroquinolone use in German ICUs with a stable volume of overall antibiotic use. The latter two antibiotic classes have .