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Influenza and acute viral syndromes

Acute viral infections can produce a variety of clinical manifestations and differing degrees of severity. The vast majority of viral infections range from asymptomatic to mild, occur in the community, and are self-limited. Rarely, acute viral infections cause severe disease, which necessitates critical care management. Common viral upper respiratory tract infections can cause serious acute exacerbations of underlying lung disease. Certain viral agents can become life-threatening…

Fungal infections

Medical advances continue to improve the prognosis of patients with cancer and other immunodeficiencies. In the past 50 years, the field of transplantation has greatly affected the management of patients with cancer and renal, cardiac, and liver diseases. Moreover, advances in neonatology continue to increase the survival of premature infants. These advances have benefited society greatly, but they have also fueled the emergence of invasive fungal…

Infectious endocarditis

Infectious endocarditis: General information Infectious endocarditis (IE) is a rare disease with a yearly crude incidence of 1.5–11.6 episodes per 100,000 persons (3–9/100,00 in developed countries), increasing dramatically with advanced age and male sex and with varying epidemiology between high- and low-income countries. , Despite advances in early diagnosis and treatment, mortality of IE at 1 year has not improved over the last decades, being ≈30%.…

Head and neck infections

Infections of the head and neck range in severity from minor to life threatening. A scoring system reflecting the need for hospitalization of such patients has been proposed. The intensivist is called upon to manage such patients either when they are critically ill or when airway compromise has occurred or is imminent. Besides airway management and control of sepsis, the intensivist must also be aware of…

Infections of skin, muscle, and necrotizing soft tissue infections

Infections are a leading cause of admission to intensive care units (ICUs). Skin and soft tissue infections (SSTIs) are both the primary cause of admission to the ICU and a complication that develops for patients with other critical illnesses. A large database review in the United Kingdom found that skin infections comprised less than 1% of all ICU admissions. Prompt recognition, diagnosis, and treatment of SSTIs…

Central nervous system infections

Central nervous system (CNS) infections represent life-threatening conditions that require emergent evaluation and frequently treatment in a critical care unit. These infections may be challenging to identify, as numerous noninfectious conditions mimic CNS infections. Even when an infectious syndrome is suspected, it may take several days before a specific microorganism is identified, necessitating the use of broad empiric therapy directed against the most likely causative pathogens…

Infections of the urogenital tract

Infections in the intensive care unit (ICU) contribute significantly to patient morbidity. Depending on the type of ICU, nosocomial infections may account for 70% of infections. Nosocomial infections of the urogenital tract are frequent and sometimes underestimated in the ICU. Definition Urinary tract infection (UTI) can be the primary cause for admission to the ICU or can be acquired after intensive care procedures. Because patients are…

Septic shock

Incidence Septic shock is a form of acute circulatory shock that occurs secondary to severe infection. The incidence of septic shock may be rising, partly related to medical progress that allows individuals to survive longer, resulting in increased numbers of older, debilitated, or immunocompromised patients passing through the intensive care unit (ICU). Some 15% of ICU patients develop septic shock at one time or another, and…

Intravascular catheter-related infections

Introduction Intravascular catheters are essential in the care of critically ill patients in order to allow safe intravenous administration of medications, help in the monitoring of hemodynamic parameters, and aid in the intravenous administration of fluid resuscitation. In European intensive care units (ICUs), the central venous catheter (CVC) utilization rate was, on average, 71 CVC days per 100 patient days. Moreover, bloodstream infections (BSIs) were catheter-related…

Selective decontamination of the digestive tract

Infections acquired in the intensive care unit (ICU) often occur during the treatment of critically ill patients, increasing their morbidity, mortality, and healthcare costs. , Several studies suggest that the use of prophylactic antibiotic regimens such as selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) can reduce the incidence of nosocomial infections and mortality in ICU patients. , , The SDD approach…

Antimicrobial agents active against anaerobic bacteria

Infections caused by anaerobic bacteria are common and may be serious and life-threatening. Anaerobes are predominant components of the bacterial flora of the normal human skin and mucous membranes and are a common cause of endogenous bacterial infections. Because of their fastidious nature, they are difficult to isolate and are often overlooked. Their isolation requires appropriate methods of collection, transportation, and cultivation. Treatment of anaerobic bacterial…

Antimicrobial agents with primary activity against gram-positive bacteria

Nosocomial infections continue to pose a significant burden on the healthcare system. The most recent summary of data reported to the National Healthcare Safety Network (NHSN) showed that gram-positive organisms remained a leading cause of healthcare–associated infections (HAIs) between 2015 and 2017. Similarly, the EPIC II study in 2007 demonstrated that gram-positive organisms were associated with 47% of infections in the intensive care unit (ICU). Staphylococcus…

Antimicrobial agents with primary activity against gram-negative bacteria

Gram-negative bacteria are ubiquitous microorganisms of particular concern, especially the gram-negative bacilli (GNB), because of the fast spread of multidrug resistance (MDR). GNBs have intrinsic abilities to find new pathways of resistance and to transmit genetic material that allows other bacteria to become resistant as well (i.e., resistance acquisition via horizontal gene transfer). Mutations lead to new phenotypes with modified antibiotic targets, such as ribosomal mutation,…

Prevention and control of nosocomial pneumonia

Pneumonia causes 79% of all infectious deaths in the United States and is a leading cause of death around the world. Although community-acquired pneumonia (CAP) causes most of these deaths, nosocomial pneumonia, both hospital-acquired pneumonia (HAP) in general and the ventilator-associated pneumonia (VAP) subset, remains an important cause of mortality and morbidity in the critically ill. Preventing pneumonia in the critically ill is a daunting task,…

Antimicrobial stewardship

Antimicrobial stewardship is an important concept that is pertinent to virtually every clinician. Its goals are to combat the emergence of resistance, improve clinical outcomes, and decrease healthcare costs ( Fig. 105.1 ). In this chapter, we will focus on the advances in and obstacles to antimicrobial stewardship as outlined in Table 105.1 by breaking this discussion into two major areas: optimization of antimicrobial therapy and…

Glomerulonephritis

Over half of all critically ill patients develop some degree of acute kidney injury (AKI), and nearly 5% require renal replacement therapy (RRT). For those patients with severe AKI requiring RRT, mortality can be as high as 70%, and up to 30% of surviving patients remain dialysis dependent. AKI may be a consequence of prerenal causes resulting in hypoperfusion of the kidneys, intrinsic kidney disease, and…

Contrast-induced acute kidney injury

Iodinated contrast agents, which are administered intravascularly for medical imaging, are widely used pharmaceutical agents: more than 80 million doses were estimated to be administered annually over a decade ago. Although vital for diagnostic and therapeutic purposes, their use can sometimes result in impairment of kidney function, resulting in a condition called contrast-induced acute kidney injury (CI-AKI) (previously known as contrast-induced nephropathy ). In most cases,…

Urinary tract obstruction

A patent urinary tract is necessary for optimal kidney function. Under normal circumstances, urine passes unimpeded from the renal pelvises to the tip of the urethra. Obstruction can occur anywhere along this pathway and may lead to both acute and progressive kidney parenchymal damage. Several definitions may be encountered when considering urinary tract obstruction: Obstructive uropathy refers to any disorder that interferes with drainage of the…

Acute kidney injury

Acute kidney injury (AKI) is recognized as one of the most serious complications in critically ill patients. It is strongly associated with higher short- and long-term mortality, increased resource utilization, and a higher risk for the development of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). AKI is defined as a sudden decrease in the glomerular filtration rate (GFR) occurring over a period of hours…