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Background  Globally ICUs are encountering emergence and spread of antibiotic-resistant pathogens and for some pathogens there are few therapeutic options available.    Methods  Antibiotic in vitro susceptibility data of predominant ICU pathogens during 2000–2 were analyzed using data from The Surveillance Network (TSN) Databases in Europe (France, Germany and Italy), Canada, and the United States (US).    Results  Oxacillin resistance rates among  Staphylococcus aureus  isolates ranged from 19.7% to 59.4%. Penicillin resistance rates among  Streptococcus pneumoniae  varied from 2.0% in Germany to as high as 20.2% in the US; however, ceftriaxone resistance rates were comparably lower, ranging from 0% in Germany to 3.4% in Italy. Vancomycin resistance rates among  Enterococcus faecalis  were ≤ 4.5%; however, among  Enterococcus faecium  vancomycin resistance rates were more frequent ranging from 0.8% in France to 76.3% in the United States. Putative rates of extended-spectrum β-lactamase (ESBL) production among  Enterobacteriaceae  were low, <6% among  Escherichia coli  in the five countries studied. Ceftriaxone resistance rates were generally lower than or similar to piperacillin-tazobactam for most of the  Enterobacteriaceae  species examined. Fluoroquinolone resistance rates were generally higher for  E. coli  (6.5% – 13.9%),  Proteus mirabilis  (0–34.7%), and  Morganella morganii  (1.6–20.7%) than other  Enterobacteriaceae  spp (1.5–21.3%).  P. aeruginosa  demonstrated marked variation in β-lactam resistance rates among countries. Imipenem was the most active compound tested against  Acinetobacter  spp., based on resistance rates.    Conclusion  There was a wide distribution in resistance patterns among the five countries. Compared with other countries, Italy showed the highest resistance rates to all the organisms with the exception of  Enterococcus  spp., which were highest in the US. This data highlights the differences in resistance encountered in intensive care units in Europe and North America and the need to determine current local resistance patterns by which to guide empiric antimicrobial therapy for intensive care infections.

Emerging resistance among bacterial pathogens in the intensive care unit--a European and North American Surveillance study (2000-2002).