The World Health Organization (WHO) proposed a global priority pathogen list (PPL) of multidrug resistant (MDR) bacteria. Our current objective was to provide global expert ranking of the most serious multi-drug resistant (MDR) bacteria present at intensive care units (ICU) that have become a threat in clinical practice. Methods: A proposal addressing a pathogens priority list (PPL) for ICU, arising from the WHO Global PPL was developed. Based on the supporting data, the pathogens were grouped in three priority tiers: Critical, high and medium. A multi-criteria decision analyses (MCDA) was used to identify the priority tiers. Results: After MCDA analysis, mortality, treatability and cost of therapy were of highest concern (scores of 19/20, 19/20 and 15/20, respectively) while dealing with PPL, followed by healthcare burden and resistance prevalence. Carbapenen-resistant (CR) Acinetobacter baumannii, Carbapenemaseexpressing Klebsiella pneumoniae (KPC) and MDR Pseudomonas aeruginosa were identified as critical organisms. High risk organisms were represented by CR Pseudomonas aeruginosa, Methicillinresistant Staphylococcus aureus, and Extended Spectrum Beta lactamase(ESBL) Enterobacteriaceae. Finally, ESBL Serratia marcescens, Vancomycin-resistant Enterococci and TMP-SMX resistant Stenotrophomonas maltophilia were identified as medium priority. Conclusions: We conclude that education, investigation, funding and development of new antimicrobials for ICU organisms should focus on Carbapenem-resistant Gram negative organisms.

Purpose of Review Ventilator-associated pneumonia (VAP) is still a common complication in intensive care units, being associated with higher costs, increasing hospital length of stay, duration of mechanical ventilation and use of antimicrobials. Ventilator care bundles are key measures to patient care quality improvement, and their implementation contributes to the reduction in the incidence of VAP. The current review focuses on preventive measures of VAP and a potential concept of zero VAP rate. Recent Findings Several reports have documented a decrease in VAP rate with the implementation of ventilator care bundles. Despite the improvement on VAP incidence, risk factors to VAP are numerous and although some are preventable, it is unachievable to eliminate the majority. Summary VAP is not always preventable and thus unlikely to reach zero rate. Several reports have documented a decrease in the incidence of VAP when a bundle is implemented. The major restrain to care bundles implementation is adherence; compliance to them is the achieving goal that can be reached by the use of a maximum of five interventions, with a strong effort on multidisciplinary education and continued feedback. Surveillance, prevention, and education remain a priority in critical care in order to minimize VAP.