Rello / Kollef / Díaz Infectious Diseases in Critical Care

2. Auflage 2007
ISBN: 978-3-540-34406-3
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 616 Seiten, eBook

Infections and their complications are a very important clinical area in the intensive care unit setting. Community-acquired infections and nosocomial infections both contribute to the high level of disease acquisition common among critically ill patients. The accurate diagnosis of nosocomial infections and the provision of appropriate therapies, including antimicrobial therapy effective against the identified agents of infection, have been shown to be important determinants of patient outcome.Critical care practitioners are in a unique position in dealing with infectious diseases. They are often the initial providers of care to seriously ill patients with infections. Additionally, they have a responsibility to ensure that nosocomial infections are prevented and that antimicrobial resistance is minimized by prudently employing antibiotic agents. It is the editors' hope that this book will provide clinicians practicing in the intensive care unit with a reference to help guide their care of infected patients. To that end they have brought together a group of international authors to address important topics related to infectious diseases for the critical care practitioner.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Rello, Jordi

Kollef, Marin

Díaz, Emili

Rodríguez, Alejandro

Kollef, Martin H.

Díaz, Emilio

Inhaltsverzeichnis

General Aspects.- Approach to the Febrile Patient in the Intensive Care Unit.- Cardiovascular Monitoring in Severe Sepsis or Septic Shock.- Cardiopulmonary Resuscitation and Infection.- Opportunistic Infections in the Intensive Care Unit: A Microbiologic Overview.- Infections in Critically Ill Solid Organ Transplant Recipients.- HIV in the Intensive Care Unit.- Fungal Infections.- Using Protocols To Improve the Outcomes of Critically Ill Patients with Infection: Focus on Ventilator-Associated Pneumonia and Severe Sepsis.- Microbial Surveillance in the Intensive Care Unit.- Use of Anti-infective Therapy in Critically III Patients.- Antimicrobial Prophylaxis in the Intensive Care Unit.- Antifungal Therapy in the Intensive Care Unit.- Dose Adjustment and Pharmacokinetics of Antibiotics in Severe Sepsis and Septic Shock.- Prescription of Antimicrobial Agents in Patients Undergoing Continuous Renal Replacement Therapy.- Methods for Implementing Antibiotic Control in the Intensive Care Unit.- Use of Antibiotics in Pregnant Patients in the Intensive Care Unit.- Immunomodulation in Sepsis.- Antibiotic Induced Diarrhea.- Infection Control/Epidemiology.- Fundamentals of Infection Control and Strategies for the Intensive Care Unit.- Antibiotic Resistance in the Intensive Care Unit.- Epidemiology of Pseudomonas aeruginosa in the Intensive Care Unit.- How To Control MRSA Spread in the Intensive Care Unit.- Epidemiology of Acinetobacter baumannii in the Intensive Care Unit.- Bloodstream Infections and Infection Disease Emergencies.- Brain Abscess.- Falciparum Malaria.- Toxic Shock Syndromes.- Acute Infective Endocarditis.- Influenza.- Bloodstream Infection in the Intensive Care Unit.- Bloodstream Infections in Patients with Total Parenteral Nutrition Catheters.- Hemodialysis Catheter-Related Infections.- Infection of Pulmonary Arterial and Peripheral Arterial Catheters.- Prevention of Catheter-Related Bloodstream Infections in Critical Care Patients.- Meningococcemia.- Septic Shock.- Respiratory Infections.- Tracheobronchitis in the Intensive Care Unit.- Severe Community-Acquired Pneumonia.- Legionnaires’ Disease.- Adjunctive and Supportive Measures for Community-Acquired Pneumonia.- Respiratory Infection in Immunocompromised Neutropenic Patients.- Pneumonia in Non-Neutropenic Immunocompromised Patients.- Community-Acquired Respiratory Complications in the Intensive Care Unit: Pneumonia and Acute Exacerbations of COPD.- Management of Hospital-Associated Pneumonia in the Intensive Care Unit.- Assessment of Resolution of Ventilator Associated Pneumonia.- Invasive Devices in the Pathogenesis of Nosocomial Pneumonia.- Infections with Surgical Implications.- Multiple Organ Dysfunction Syndrome.- Sepsis in Obstetrics.- Diagnosis and Management of Intra-abdominal Sepsis.- Surgical Site Infection Control in the Critical Care Environment.- Severe Soft Tissue Infections: A Syndrome-Based Approach.- Vascular Graft Infections.- Acute Mediastinitis.- Pancreatic Infection.- Urinary Tract Infections.- Neurosurgical Infections in Intensive Care Unit Patients.- Biliary Tract Infections.

Leseproben

"35 Tracheobronchitis in the Intensive Care Unit (p. 385-386)

L. Morrow, D. Schuller

35.1 Introduction

Tracheobronchitis can be broadly defined as inflammation of the airways between the larynx and the bronchioles. Clinically, this syndrome is recognized by an increase in the volume and purulence of the lower respiratory tract secretions and is frequently associated with signs of variable airflow obstruction. In the intensive care unit (ICU), tracheobronchitis is a relatively common problem with an incidence as high as 10.6% [1]. Although tracheobronchitis is associated with a significantly longer length of ICU stay and a prolonged need for mechanical ventilation, it has not been shown to increase mortality.

These outcomes can be improved through the use of antimicrobial agents [1]. Tracheobronchitis results fromtwo dominating processes: colonization of the oropharynx and its contiguous structures (dental plaque, the sinuses, the stomach) by potentially pathogenic organisms and aspiration of contaminated secretions from these anatomic sites [2]. Mechanically ventilated patients are particularly at risk for tracheobronchitis given the presence of an endotracheal tube.

These devices contribute to the pathogenesis of tracheobronchitis (and pneumonia) in a variety of manners: bypassing natural host defenses, acting as a nidus for biofilm formation, allowing pooled secretions and bacteria to leak around the cuff and into the trachea, damaging the ciliated epithelium and reducing bacterial clearance directly or via frequent suctioning to maintain airway patency [3, 4]. In contrast to nosocomial pneumonia, nosocomial tracheobronchitis does not involve pulmonary parenchyma and, thus, does not cause radiographic pulmonary infiltrates. However, high quality portable chest radiographs may be difficult to obtain in the ICU, where poor patient cooperation, inconsistent technique and other obstacles lead to suboptimal studies [5].

Furthermore, common processes such as atelectasis, pulmonary edema, or pleural effusions can cause infiltrates that mimic pneumonia making the clinical distinction between pneumonia and tracheobronchitis difficult [6].

35.2 Bacterial Tracheobronchitis

Bacterial infection is the most common cause of infectious tracheobronchitis in the ICU. Infectious tracheobronchitis is clinically diagnosed when a patient develops fever, purulent respiratory secretions, and leukocytosis but the chest radiograph shows no new infiltrate [7].  Tracheobronchitis is “microbiologically confirmed” when a patient with clinically diagnosed tracheobronchitis yields culture specimens that identify a causative pathogen at appropriately high densities.

When a patient lacks fever or leukocytosis (or if culture specimens reveal few organisms) the differentiation between colonization and infection is difficult and controversial. Furthermore, the significance of tracheobronchial colonization as a risk factor for subsequent lower respiratory tract infection remains unclear.

Alterations in the oropharyngeal flora of the hospitalized host have been associated with several factors including age, severity of acute illness, comorbid chronic illnesses, and duration of hospitalization [8–10]. One study of outpatients with chronic tracheostomy concluded that although these patients were routinely colonized with massive amounts of potentially pathogenic bacteria, rates of severe respiratory tract infections were low [11]."