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Abstract
Infection is responsible for a large proportion of the mortality in ICUs Even
when antibiotics to which the responsible organism displays in vitro
sensitivity and even when meticulous monitoring of antibiotic therapy and
blood levels of the antibiotic used are taken care of, mortality from
infection often approaches 50%. Thus, understanding the origin of infection
in these patients, methods of early diagnosis, and the scrupulous
employment of preventive measures known to be effective in minimizing
the incidence of infection, as well as prompt treatment when indicated, is of
utmost importance.
The pathological features of infection in the critically ill patient have
been discussed. Patients in ICUs are vulnerable to infection due either to
their primary disease which was the cause of their admission to the
ICU, due to the use of drugs affecting, the immune system, violation of
normal anatomic barriers by invasive techniques, or compromise of their
humoral and cell mediated immunity in various forms.
The source of infection may be exogenous (from the environment)
acquired- either in the ICU, in the community or in other wards of the
hospital prior to admission to the ICU, or it may be endogenous (from the
patient’s own bacteria present in the stomach or intestines). The accused
organism may be bacterial, fungal, viral or protozoal. The pattern of
infection in ICUs varies from one unit to the other, and from time to time.
Staff should be aware of the pattern of infection which may be expected in
their own units so that when necessary, empirical treatment may be
directed at the most likely pathogen.
Various sites of infection in the ICU patients are discussed.
Respiratory tract infections may be caused by nebulizers, humidifiers, and
Summary
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IPPV. Urinary tract infections are mainly due to improper care for urinary
catheters. Parenteral line infections can occur either from IV catheters and
cannulae, IV fluids and containers or blood and blood products. Surgical
wound infections, intra-abdominal infections and other sites of infection
have been enlightened.
As regards diagnosis of infection, cardinal manifestations of
infection mainly in the form of fever and leucocytosis, in addition to
symptoms and signs specific to each-site of infection of significance to the
ICU, and the use of various investigatory procedures each in its place
when indicated have been outlined.
An ounce of prevention is worth a pound of cure. Thus, prevention
of infection in ICU being our main aim is detailed. The most common
nosocomial infections in the critical care patient are iatrogenic infections
associated with a failure to follow simple prophylactic procedures. The role
of handwashing with good mechanical friction, and disinfection using
different antiseptic agents is demonstrated. The effects of the use of gloves و
gowns and the design of ICUs are shown. Guidelines for care of
insertion and maintenance of intravenous cannulation are discussed.
Prevention of contamination and care of delivery systems, prevention of
infections due to contaminated blood and blood products and other blood
borne infections are briefly outlined.
Care of respiratory assist devices and urinary catheters is
included. Prevention of endogenous infection and various regimens for
selective decontamination of the digestive tract are also outlined.
Finally, the treatment of ICU infections is discussed. Supportive
therapy gains time for definitive treatment to be effective. It includes
support of respiration, support of the cardiovascular system, and support of
renal, hepatic and cerebral functions. Elimination of septic foci, control of
Summary
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mediators of the sepsis syndrome and nutritional and metabolic support are
also important. Last but not least, antibiotic therapy is demonstrated.
Without the preceding measures, antibiotics may well be useless.
Very, often, as when signs of cardiovascular- instability appear, empirical
treatment using antibiotics is needed before an organism can he identified.
Under these circumstances material for culture and sensitivity from all
possible sites of infection should be obtained. Antibiotics are
discussed in groups.
Combinations of antibiotics are outlined. Suggested antibiotic
regimens for common infections in the intensive care unit are
demonstrated.