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Recent studies in mixed populations demonstrate increased antimicrobial use, poorer patient outcomes and development of microbiological resistance in those with an antibiotic allergy label [ 3– 5].
In spite of a large number of positive studies [ 54], many physicians are reluctant to adopt this intervention, owing to concerns with microbiological resistance.
All patients received conventional intensive care therapies in accordance with the international sepsis guidelines [ 14], as intubation and mechanical ventilation with a tidal volume of 6 mL/kg and an upper limit plateau pressure <30 cmH2O, sedation by continuous infusion according to clinical requirements, and intravenous antibiotics as indicated by microbiological resistance testing.
In this situation, due to the importance that tigecycline can have in the treatment of MDR A. baumannii infections, it is absolutely mandatory to monitor isolates for evidence of acquired microbiological resistance, requiring further investigations to understand better all the possible mechanisms underlying this phenomenon.
Therefore, consideration of need (prevalence, baseline risk or health status), setting (e.g. availability of resources) and modifying factors (factors that modify translation of recommendation into practice such as microbiological resistance patterns) can be key components that influence the strength of a recommendation and should be specified in recommendations formulated by the WHO [ 33].
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Resistance rates were based on coliforms in urine samples routinely submitted to laboratories from general practice for microbiological analysis (resistance in urinary tract infection is associated with prescribing for other infections and large numbers of urine samples are routinely sent for microbiological analysis).
Culture results with microbiological identification and resistance patterns were reported to the treating physicians within 2 days after sampling.
No significant differences were found in the microbiological isolation, bacterial resistance and antibiotic therapy used in the two groups, which may suggest that therapeutic approach may be similar to that recommended for NAV.
The appropriateness of antimicrobial prescriptions was evaluated according to local and international evidence-based guidelines, and considering local epidemiology of antimicrobial resistance, microbiological findings, if available, and co-morbidity.
GNB screening: In patients admitted to the ICU, rectal and nose swabs were sent at admission for microbiological evaluation antibiotic resistance in GNB.
MW conceived the study, participated in its design, carried out the microbiological analysis (cultures, resistance testing, MLVA typing) and drafted the manuscript.
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