Antibiotic cycling in ICUs: Rational science or going round in circles?

Antibiotics have an important role in the management of patients in intensive care units (ICUs), as these patients carry a high burden of infection, due to a multiplicity of factors (Table 1). This is exemplified by the results of a one-day point prevalence study involving over 10,000 patients that was carried out in 1,417 ICUs in 17 countries in western Europe, which showed that the overall rate of infection was 44%. Unfortunately, the substantial quantities of antibiotics used in most ICUs generate a strong selection pressure for the emergence and persistence of antibiotic-resistant bacteria, the evidence for this being the reproducible finding that the prevalence of antibiotic resistance is higher in ICUs than in other hospital settings or among outpatients.