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Bloodstream Infection in the ICU Patient

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Infection Control in the Intensive Care Unit

Abstract

Patients admitted to intensive care units (ICUs) are at high risk of hospital-acquired infections, especially bloodstream infection (BSI). On the other hand, a high percentage of patients admitted to ICUs because community-acquired infections have bacteriemia. The incidence of hospital-acquired BSI ranges from 27 to 68 episodes per 1,000 admissions, depending on the prevalence of several patient conditions (hematologic and nonhematologic malignancies, diabetes mellitus, renal failure requiring dialysis, chronic hepatic failure, immune deficiency syndromes, serious burns, and pressure ulcers) or invasive therapeutic maneuvers, such as intravascular and urinary catheter placement, endoscopic procedures, and drainage of intra-abdominal infections. Regarding the microbiology of these infections, staphylococci (mainly coagulase-negative staphylococci) and Gram-negative bacilli account for the vast majority. The crude mortality rate range from 20 to 60%, and the mortality rate directly attributable to BSI infection ranges from 14 to 38%. As intravascular catheters are the main source of hospital-acquired BSI in the ICU, prevention strategies focus on catheter care. The rate of community-acquired bloodstream infections in the ICU is about 10.2 episodes per 1,000 admissions, and the mortality rate is 40%. The incidence of Gram-positive microorganisms is similar to that of Gram-negatives, and close to 10% are polymicrobial episodes, with Escherichia coli, Streptococcus pneumoniae and Staphylococcus aureus being the leading pathogens. Fifty percent of these community-acquired infections are, in fact, health-care-related infections, affecting older patients with comorbidities and with higher incidence of resistant pathogens. The mainstay of therapy is early appropriate antibiotic treatment, source control when needed, and optimal shock management.

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Authors and Affiliations

  1. Critical Care Center, Hospital Sabadell, Sabadell, Barcelona, Spain

    J. Vallés & R. Ferrer

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  1. J. Vallés
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  2. R. Ferrer
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Correspondence to J. Vallés .

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Editors and Affiliations

  1. , Institute of Aging and Chronic Diseases, University Liverpool, Daulby Street, Liverpool, L69 3GA, United Kingdom

    Hendrick K.F. van Saene

  2. , Dept. Emergency, Hospital Gorizia, Via Vittorio Veneto 171, Gorizia, 34170, Italy

    Luciano Silvestri

  3. , Department of Intensive Care Medicine, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, 28045, Spain

    Miguel A. de la Cal

  4. Policlinico di Catania, UCO di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria, Via Santa Sofia 78, Catania, 95100, Italy

    Antonino Gullo

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Vallés, J., Ferrer, R. (2011). Bloodstream Infection in the ICU Patient. In: van Saene, H., Silvestri, L., de la Cal, M., Gullo, A. (eds) Infection Control in the Intensive Care Unit. Springer, Milano. https://doi.org/10.1007/978-88-470-1601-9_15

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  • DOI: https://doi.org/10.1007/978-88-470-1601-9_15

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  • Publisher Name: Springer, Milano

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  • Online ISBN: 978-88-470-1601-9

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