Infections in the Intensive Care Unit

  • Jaclyn Rosenzweig
  • Gregory J. Rossini
  • Rafik Samuel
  • Wissam Chatila


After studying this chapter, you should be able to: Understand the pathophysiology of specific infections in the ICU. Identify infectious complications in critically ill patients. Conduct appropriate diagnostic work-up for infections encountered in the ICU. Develop a systematic approach for managing ICU-related infections. Execute effective measures to prevent infectious complications in the ICU. Understand how to effectively work up and treat patients with sepsis. Choose the appropriate antimicrobial regimen for either empiric or culture-focused treatment of ICU infections.


Antimicrobial Therapy Empiric Therapy Nosocomial Pneumonia Pseudomembranous Colitis Pneumonia Severity Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Jackson ML, Neuzil KM, Thompson WW, et al. The burden of community-acquired pneumonia in seniors: results of a population-based study. Clin Infect Dis. 2004;39:1642-1650.PubMedCrossRefGoogle Scholar
  2. 2.
    Deresinski S. Methicillin-resistant Staphylococcus aureus: an evolutionary, epidemiologic, and therapeutic odyssey. Clin Infect Dis. 2005;40:562-573.PubMedCrossRefGoogle Scholar
  3. 3.
    Roson B, Carratala J, Verdaguer R, Dorca J, Manresa F, Gudiol F. Prospective study of the usefulness of sputum gram stain in the initial approach to community-acquired pneumonia requiring hospitalization. Clin Infect Dis. 2000;31:869-874.PubMedCrossRefGoogle Scholar
  4. 4.
    Schuchat A, Robinson K, Wenger JD, et al. Bacterial meningitis in the united states in 1995. N Engl J Med. 1997;337:970-976.PubMedCrossRefGoogle Scholar
  5. 5.
    van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351:1849-1859.PubMedCrossRefGoogle Scholar
  6. 6.
    de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347:1549-1556.PubMedCrossRefGoogle Scholar
  7. 7.
    Scarborough M, Gordon SB, Whitty CJ, et al. Corticosteroids for bacterial meningitis in adults in sub-saharan Africa. N Engl J Med. 2007;357:2441-2450.PubMedCrossRefGoogle Scholar
  8. 8.
    Nguyen TH, Tran TH, Thwaites G, et al. Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. N Engl J Med. 2007;357:2431-2440.PubMedCrossRefGoogle Scholar
  9. 9.
    Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003;348:138-150.PubMedCrossRefGoogle Scholar
  10. 10.
    Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546-1554.PubMedCrossRefGoogle Scholar
  11. 11.
    Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008;358: 111-124.PubMedCrossRefGoogle Scholar
  12. 12.
    Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125-139.PubMedCrossRefGoogle Scholar
  13. 13.
    Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165:867-903.PubMedGoogle Scholar
  14. 14.
    Fridkin SK. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med. 2001;29:N64-N68.PubMedCrossRefGoogle Scholar
  15. 15.
    Chastre J, Wolff M, Fagon JY, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290:2588-2598.PubMedCrossRefGoogle Scholar
  16. 16.
    Davis K Jr, Johannigman JA, Campbell RS, et al. The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury. Crit Care. 2001;5: 81-87.PubMedCrossRefGoogle Scholar
  17. 17.
    Kollef MH. The prevention of ventilator-associated pneumonia. N Engl J Med. 1999;340:627-634.PubMedCrossRefGoogle Scholar
  18. 18.
    Sherertz RJ, Heard SO, Raad II. Diagnosis of triple-lumen catheter infection: comparison of roll plate, sonication, and flushing methodologies. J Clin Microbiol. 1997;35:641-646.PubMedGoogle Scholar
  19. 19.
    Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med. 1977;296:1305-1309.PubMedCrossRefGoogle Scholar
  20. 20.
    Fan ST, Teoh-Chan CH, Lau KF. Evaluation of central venous catheter sepsis by differential quantitative blood culture. Eur J Clin Microbiol Infect Dis. 1989;8:142-144.PubMedCrossRefGoogle Scholar
  21. 21.
    Blot F, Schmidt E, Nitenberg G, et al. Earlier positivity of central-venous-versus peripheral-blood cultures is highly predictive of catheter-related sepsis. J Clin Microbiol. 1998;36:105-109.PubMedGoogle Scholar
  22. 22.
    Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect. 1998;40:1-15.PubMedCrossRefGoogle Scholar
  23. 23.
    McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989;320:204-210.PubMedCrossRefGoogle Scholar
  24. 24.
    McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005;353:2433-2441.PubMedCrossRefGoogle Scholar
  25. 25.
    Teasley DG, Gerding DN, Olson MM, et al. Prospective randomised trial of metronidazole versus vancomycin for Clostridium-difficile-associated diarrhoea and colitis. Lancet. 1983;2: 1043-1046.PubMedCrossRefGoogle Scholar
  26. 26.
    Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007;45:302-307.PubMedCrossRefGoogle Scholar
  27. 27.
    Platt R, Polk BF, Murdock B, Rosner B. Risk factors for nosocomial urinary tract infection. Am J Epidemiol. 1986;124:977-985.PubMedGoogle Scholar

Additional Reading

  1. §Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27-S72.PubMedCrossRefGoogle Scholar
  2. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267-1284.PubMedCrossRefGoogle Scholar
  3. Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296-327.PubMedCrossRefGoogle Scholar
  4. §§American Thoracic Society and the Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171: 388-416.CrossRefGoogle Scholar
  5. °Mermel LA, Farr BM, Sherertz RJ, et al. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis. 2001;32:1249-1272.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Jaclyn Rosenzweig
    • 1
  • Gregory J. Rossini
    • 2
  • Rafik Samuel
    • 3
  • Wissam Chatila
    • 4
  1. 1.Section of Infectious DiseasesTemple University School of MedicinePhiladelphiaUSA
  2. 2.Department of Pulmonary MedicineLancaster General HospitalLancasterUSA
  3. 3.Section of Infectious DiseasesTemple University School of MedicinePhiladelphiaUSA
  4. 4.Division of Pulmonary and Critical Care MedicineTemple University School of MedicinePhiladelphiaUSA

Personalised recommendations