BOOK
Complex Infectious Disease Issues in the Intensive Care Unit, An Issue of Infectious Disease Clinics of North America, E-Book
Naomi P. O'Grady | Sameer S Kadri
(2017)
Additional Information
Book Details
Abstract
The Guest Editors, coming from the Critical Care Medicine Department in the NIH, are the top thought leaders in the area of infections in critical care. Their topic selections in this issue reflect the most clinically relevant and current information. The issue specifically covers the following topics: Catheter-related bloodstream infections: special considerations in diagnosis in the ICU; Sepsis-How does the new definition help clinicians; Therapeutic drug monitoring of antibiotics; High containment pathogen preparation; Multidrug resistant gram negative infections and enterococcus; Strategies to prevent transmission of resistant organisms; Antibiotic Stewardship: What the intensivist should know; C. Difficile infection in the ICU; Immunocompromised critically ill; Rapid diagnostics: The use of procalcitonin; Respiratory viruses in the ICU: Significance of rhino/rsv updates/adenovirus metapneumovirus; Management of invasive fungal disease in the ICU; Inhaled/Nebulized antibiotics. Infectious disease physicians and intensivists will be armed with the information they need to diagnose and treat patients with infections in the ICU.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Complex InfectiousDisease Issues in theIntensive Care Unit\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Preface: On the Interface of Infectious Diseases and Critical Care Medicine | vii | ||
| New Sepsis and Septic Shock Definitions: Clinical Implications and Controversies | vii | ||
| Sepsis and Challenging Infections in the Immunosuppressed Patient in the Intensive Care Unit\r | vii | ||
| Role of Procalcitonin in the Management of Infected Patients in the Intensive Care Unit | vii | ||
| Severe Respiratory Viral Infections: New Evidence and Changing Paradigms | vii | ||
| Invasive Fungal Infections in the Intensive Care Unit | viii | ||
| Clostridium difficile Infection | viii | ||
| Evaluation and Management of Necrotizing Soft Tissue Infections | viii | ||
| Antimicrobial Stewardship Approaches in the Intensive Care Unit | viii | ||
| Preventing Transmission of Multidrug-Resistant Pathogens in the Intensive Care Unit | ix | ||
| Prevention of Central Line–Associated Bloodstream Infections | ix | ||
| High-Containment Pathogen Preparation in the Intensive Care Unit | ix | ||
| Inhaled Antibiotics for Ventilator-Associated Infections | ix | ||
| INFECTIOUS DISEASE CLINICS\rOF NORTH AMERICA\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| December 2017 | xi | ||
| March 2018 | xi | ||
| June 2018 | xi | ||
| RECENT ISSUES | xi | ||
| March 2017 | xi | ||
| June 2017 | xi | ||
| December 2016 | xi | ||
| Preface:\rOn the Interface of Infectious Diseases and Critical Care Medicine | xiii | ||
| New Sepsis and Septic Shock Definitions | 397 | ||
| Key points | 397 | ||
| INTRODUCTION | 398 | ||
| SEPSIS BURDEN AND NEW QUALITY MEASURES | 398 | ||
| CHALLENGES IN DEFINING AND TRACKING SEPSIS | 398 | ||
| PRIOR SEPSIS DEFINITIONS | 399 | ||
| WHY REVISE THE DEFINITION? | 399 | ||
| SEPSIS-3: SEQUENTIAL ORGAN FAILURE ASSESSMENT, QUICK SEQUENTIAL ORGAN FAILURE ASSESSMENT, AND SEPTIC SHOCK | 400 | ||
| STRENGTHS OF SEPSIS-3 | 403 | ||
| POTENTIAL WEAKNESSES AND CRITICISMS OF SEPSIS-3 | 403 | ||
| Using the New Sepsis Criteria Has Not Been Shown to Improve Clinical Outcomes | 403 | ||
| Potential Delays in Early Identification and Treatment | 404 | ||
| Sequential Organ Failure Assessment Score: An Unfamiliar Clinical Tool Specific to the Intensive Care Unit | 404 | ||
| Neither Sequential Organ Failure Assessment nor Quick Sequential Organ Failure Assessment Helps Identify Infection | 405 | ||
| Risk of Confusion with Concurrent Definitions | 405 | ||
| PRESSING QUESTIONS AND CONTROVERSIES SURROUNDING SEPSIS-3 AND CLINICAL MANAGEMENT | 405 | ||
| Is There Still a Role for Systemic Inflammatory Response Syndrome Criteria? | 405 | ||
| Is Quick Sequential Organ Failure Assessment a Replacement for Systemic Inflammatory Response Syndrome? | 406 | ||
| What Is the Best Screening Tool for Sepsis? | 406 | ||
| What Is the Role of Lactate Testing with Sepsis-3? | 407 | ||
| Should Clinicians Routinely Measure Sequential Organ Failure Assessment Scores? | 407 | ||
| FINAL CAVEATS ON SEPSIS-3 | 407 | ||
| SUMMARY | 408 | ||
| REFERENCES | 409 | ||
| Sepsis and Challenging Infections in the Immunosuppressed Patient in the Intensive Care Unit | 415 | ||
| Key points | 415 | ||
| INTRODUCTION | 415 | ||
| CLINICAL SYNDROMES | 416 | ||
| Vascular Access Device–Related Infections | 416 | ||
| Pneumonia | 416 | ||
| Mediastinitis | 417 | ||
| Acute Abdomen | 418 | ||
| Sepsis and Neutropenic Fever | 418 | ||
| Urinary Tract Infections | 419 | ||
| Organisms of Special Interest | 419 | ||
| Clostridium difficile | 419 | ||
| Nocardiosis | 420 | ||
| Pneumocystis jirovecii infections | 420 | ||
| Aspergillosis | 421 | ||
| Cytomegalovirus | 421 | ||
| Respiratory viruses | 422 | ||
| Noroviruses | 423 | ||
| Strongyloidiasis | 423 | ||
| SELECTED SEVERE INFECTIONS IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS | 424 | ||
| Pneumonia and Human Immunodeficiency Virus | 424 | ||
| Sepsis and Human Immunodeficiency Virus | 425 | ||
| Toxoplasmosis, Cryptococcosis, Bartonellosis, and Human Immunodeficiency Virus | 425 | ||
| Endemic Fungal Infections and Human Immunodeficiency Virus | 425 | ||
| Cytomegalovirus and Human Immunodeficiency Virus | 426 | ||
| SUMMARY | 426 | ||
| REFERENCES | 427 | ||
| Role of Procalcitonin in the Management of Infected Patients in the Intensive Care Unit | 435 | ||
| Key points | 435 | ||
| INTRODUCTION | 435 | ||
| SEVERE COMMUNITY-ACQUIRED PNEUMONIA | 436 | ||
| Standard Diagnostic Methods | 436 | ||
| Addition of Molecular Diagnostics | 436 | ||
| Colonization or infection: procalcitonin | 437 | ||
| Procalcitonin levels distinguish viral and bacterial infection | 437 | ||
| Value of viral detection and procalcitonin levels in patients with community-acquired pneumonia | 438 | ||
| Influence of renal function on interpretation of serum procalcitonin levels | 439 | ||
| Two benefits of sequential procalcitonin levels | 440 | ||
| Community-acquired pneumonia summary | 440 | ||
| Community-acquired pneumonia: the future of diagnostics | 441 | ||
| SEPTIC SHOCK AND PROCALCITONIN | 441 | ||
| Case Presentations | 441 | ||
| Case 1 | 441 | ||
| Case 2 | 441 | ||
| Procalcitonin and Etiology of Shock | 441 | ||
| Translocation of Gut Bacteria | 442 | ||
| Serum Soluble CD14 (Presepsin) | 442 | ||
| Negative Predictive Value in Patients with Shock | 443 | ||
| Procalcitonin, Source Control, and Mortality | 443 | ||
| Procalcitonin Levels and Individualization of Treatment | 444 | ||
| Subsummary: What Does, and What Does Not, Increase the Serum Concentration of Procalcitonin? | 444 | ||
| SUMMARY | 446 | ||
| REFERENCES | 446 | ||
| Severe Respiratory Viral Infections | 455 | ||
| Key points | 455 | ||
| THE EVOLVING EPIDEMIOLOGY OF SEVERE RESPIRATORY INFECTIONS | 456 | ||
| RHINOVIRUS | 458 | ||
| Rhinovirus Infection in Adults | 459 | ||
| Clinical Presentation and Diagnosis | 459 | ||
| Treatment | 460 | ||
| HUMAN ADENOVIRUSES | 460 | ||
| Human Adenovirus Infection in Adults | 460 | ||
| Clinical Presentation and Diagnosis | 461 | ||
| Treatment | 461 | ||
| RESPIRATORY SYNCYTIAL VIRUS | 462 | ||
| Respiratory Syncytial Virus Infection in Adults | 462 | ||
| Clinical Presentation and Diagnosis | 463 | ||
| Treatment | 464 | ||
| HUMAN METAPNEUMOVIRUS | 464 | ||
| Human Metapneumovirus Infection in Adults | 464 | ||
| Clinical Presentation and Diagnosis | 465 | ||
| Treatment | 465 | ||
| CHALLENGES AND FUTURE DIRECTIONS | 466 | ||
| REFERENCES | 466 | ||
| Invasive Fungal Infections in the Intensive Care Unit | 475 | ||
| Key points | 475 | ||
| INVASIVE CANDIDIASIS | 475 | ||
| RISK FACTORS | 476 | ||
| DIAGNOSIS | 476 | ||
| PROPHYLAXIS AND TREATMENT | 478 | ||
| TREATMENT | 478 | ||
| ASPERGILLOSIS | 479 | ||
| DIAGNOSIS | 479 | ||
| TREATMENT | 481 | ||
| SUMMARY | 482 | ||
| REFERENCES | 482 | ||
| Clostridium difficile Infection | 489 | ||
| Key points | 489 | ||
| HISTORICAL BACKGROUND | 489 | ||
| INTENSIVE CARE UNIT ISSUES | 490 | ||
| CLINICAL FEATURES | 490 | ||
| RISK | 490 | ||
| TESTING FOR CLOSTRIDIUM DIFFICILE INFECTION | 491 | ||
| TREATMENT | 491 | ||
| ROLE OF SURGERY | 492 | ||
| RELAPSING CLOSTRIDIUM DIFFICILE INFECTION | 492 | ||
| STOOL TRANSPLANT | 492 | ||
| PREVENTION | 493 | ||
| FUTURE | 493 | ||
| REFERENCES | 493 | ||
| Evaluation and Management of Necrotizing Soft Tissue Infections | 497 | ||
| Key points | 497 | ||
| INTRODUCTION | 497 | ||
| PATHOPHYSIOLOGY | 498 | ||
| DIAGNOSIS | 500 | ||
| Clinical Assessment | 500 | ||
| Laboratory Values and Scoring Systems | 500 | ||
| Imaging | 501 | ||
| Bedside Exploration and Biopsy | 503 | ||
| TREATMENT | 503 | ||
| Antibiotic Therapy | 503 | ||
| Surgical Intervention | 504 | ||
| Adjuvant Therapies | 506 | ||
| SUMMARY | 507 | ||
| REFERENCES | 507 | ||
| Antimicrobial Stewardship Approaches in the Intensive Care Unit | 513 | ||
| Key points | 513 | ||
| CASE PRESENTATIONS | 513 | ||
| BACKGROUND | 514 | ||
| GENERAL ANTIMICROBIAL STEWARDSHIP APPROACHES | 515 | ||
| DIAGNOSIS | 516 | ||
| Host Response to Infection | 517 | ||
| The Role of Traditional Microbiology Testing | 517 | ||
| Rapid Microbial Identification and Susceptibility Testing | 519 | ||
| Diagnostic Testing Take-Home Points | 520 | ||
| EMPIRICAL THERAPY | 520 | ||
| Guidelines | 520 | ||
| Computerized Decision Support to Assist with Empirical Antibiotic Choice | 521 | ||
| Formulary Restriction | 522 | ||
| Allergy Testing | 523 | ||
| Antimicrobial Stewardship Strategies to Guide Empirical Therapy Take-Home Points | 523 | ||
| DEFINITIVE THERAPY | 523 | ||
| Prospective Audit and Feedback | 524 | ||
| Antibiotic Time-Out | 524 | ||
| Infectious Disease Physician Embedding Within the Intensive Care Unit Rounding Structure | 524 | ||
| Studies of Duration | 525 | ||
| Dosing Strategies | 525 | ||
| Antimicrobial Stewardship Strategies to Guide Definitive Therapy Take-Home Points | 525 | ||
| DEMONSTRATING EFFECTIVENESS | 526 | ||
| SUMMARY | 526 | ||
| REFERENCES | 526 | ||
| Preventing Transmission of Multidrug-Resistant Pathogens in the Intensive Care Unit | 535 | ||
| Key points | 535 | ||
| INTRODUCTION | 535 | ||
| Importance of Preventing Transmission of Resistant Organisms | 536 | ||
| Transmission of Resistant Organisms in the intensive Care Unit | 536 | ||
| ANTIMICROBIAL STEWARDSHIP | 537 | ||
| Hand Hygiene | 537 | ||
| MANAGEMENT OF ANTIBIOTIC-RESISTANT ORGANISM COLONIZATION | 538 | ||
| Microbial Screening | 538 | ||
| Isolation Precautions | 539 | ||
| Empiric Isolation | 540 | ||
| Decolonization and Skin Antisepsis | 540 | ||
| Preventing transmission from the intensive care unit environment | 541 | ||
| Preventing transmission of methicillin-resistant Staphylococcus aureus | 542 | ||
| Preventing transmission of vancomycin-resistant Enterococcus faecium | 543 | ||
| Preventing transmission of resistant gram-negative bacteria | 543 | ||
| Multidrug-resistant Acinetobacter baumannii | 544 | ||
| Candida auris | 544 | ||
| SUMMARY | 545 | ||
| REFERENCES | 545 | ||
| Prevention of Central Line–Associated Bloodstream Infections | 551 | ||
| Key points | 551 | ||
| INTRODUCTION | 551 | ||
| DEFINITIONS | 551 | ||
| CLOSED INTENSIVE CARE UNIT VERSUS OPEN INTENSIVE CARE UNIT | 553 | ||
| Site Selection for Catheterization | 553 | ||
| Do all Catheter Placements Require Ultrasonography Guidance? | 553 | ||
| What Kind of Venous Catheter Should Be Used? | 554 | ||
| Single-lumen versus multilumen catheters | 554 | ||
| Antibiotic-impregnated and antiinfective-impregnated catheters | 554 | ||
| Catheter removal | 554 | ||
| Guidewire exchange | 555 | ||
| Insertion Technique | 555 | ||
| Catheter Dressing and Maintenance | 555 | ||
| Chlorhexidine-impregnated dressings | 555 | ||
| Needleless securement devices | 556 | ||
| Disinfection caps | 556 | ||
| SUMMARY | 557 | ||
| REFERENCES | 557 | ||
| High-Containment Pathogen Preparation in the Intensive Care Unit | 561 | ||
| Key points | 561 | ||
| INTRODUCTION | 561 | ||
| THE ENVIRONMENT | 562 | ||
| Location of the Unit | 562 | ||
| Layout of the Care Space | 562 | ||
| Air Handling | 563 | ||
| Decontamination of the Environment | 564 | ||
| Equipment | 564 | ||
| Imaging and other diagnostic technology | 564 | ||
| Communication | 564 | ||
| Reusing equipment and supplies | 565 | ||
| Waste management | 565 | ||
| Transportation | 565 | ||
| CLINICAL CARE | 566 | ||
| Multidisciplinary Teams | 566 | ||
| Staffing | 568 | ||
| Personal Protective Equipment | 568 | ||
| Clinical Protocols | 569 | ||
| Laboratory Testing | 570 | ||
| Training | 570 | ||
| DISCUSSION | 571 | ||
| ACKNOWLEDGMENTS | 571 | ||
| REFERENCES | 572 | ||
| Inhaled Antibiotics for Ventilator-Associated Infections | 577 | ||
| Key points | 577 | ||
| INTRODUCTION | 577 | ||
| BACKGROUND | 578 | ||
| RATIONALE FOR AEROSOLIZED ANTIBIOTIC THERAPY IN VENTILATED PATIENTS | 580 | ||
| Inhaled Antibiotics Therapy for Prevention of Ventilator-associated Pneumonia | 580 | ||
| EVIDENCE FOR TREATING VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS AND/OR VENTILATOR-ASSOCIATED PNEUMONIA: META-ANALYSES OF TREA ... | 581 | ||
| Rationale for Inhaled Colistin for Ventilator-associated Pneumonia | 582 | ||
| RANDOMIZED CONTROLLED TRIALS OF AEROSOLIZED ANTIBIOTICS FOR VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS OR VENTILATOR-ASSOCIATE ... | 584 | ||
| HOW DO AEROSOLIZED ANTIBIOTICS AFFECT EMERGENCE OF BACTERIAL RESISTANCE COMPARED WITH SYSTEMIC ANTIBIOTICS? | 585 | ||
| FUTURE RESEARCH | 587 | ||
| SUMMARY | 588 | ||
| ACKNOWLEDGMENTS | 588 | ||
| REFERENCES | 588 |