Critical care clinics
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Clostridium difficile is an anaerobic, spore-forming, gram-positive bacillus that can produce severe colitis resulting in death. There has been an overall increase in the incidence of Clostridium difficile-associated disease and, particularly, an increase in the more virulent forms of the disease. Treatment of severe C difficile infection includes management of severe sepsis and shock, pathogen-directed antibiotic therapy, and, in selected cases, surgical intervention. Ultimately, prevention is the key to limiting the devastating effects of this microorganism.
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Infective endocarditis has many facets and various expressions depending on the site of infection, microorganism, underlying heart lesion, immune status of the host, and remote effects such as emboli, organ dysfunction, and the condition of the host. Diagnosis depends on meticulous clinical examination, blood cultures results, and echocardiographic findings. The management of the patient with endocarditis in the intensive care unit is complex and needs a multidisciplinary team, including an intensivist, cardiologist, experienced echocardiologist, infectious diseases specialist, and cardiac surgeon. The medical and surgical management of such patients is complex, and timely decisions are important.
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This article focuses on the pathogenesis, diagnosis, prevention, and management of infectious complications of intravascular cannulation and fluid infusion. Although continuous vascular access is one of the most essential modalities in modern-day medicine, there is a substantial and underappreciated potential for producing iatrogenic complications, the most important of which is blood-borne infection. Clinicians often fail to consider the diagnosis of infusion-related sepsis because clinical signs and symptoms are indistinguishable from bloodstream infections arising from other sites. Understanding and consideration of the risk factors predisposing patients to infusion-related infections may guide the development and implementation of control measures for prevention.
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Critical care clinics · Oct 2013
ReviewOther Viral Pneumonias: Coronavirus, Respiratory Syncytial Virus, Adenovirus, Hantavirus.
Severe viral pneumonia is an increasing problem among adults. The incidence and number of viruses known to cause pneumonia and respiratory failure have also expanded in recent years. ⋯ Management of individual cases is mainly supportive and requires institution of appropriate infection control measures. Vaccines and effective therapeutics for these potentially devastating respiratory viruses are urgently required.
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Modern post-transplant care pathways commonly encompass periods of critical care support. Infectious events account for many of these interactions making critical care physicians integral members of multidisciplinary transplant teams. ⋯ Individualized risk assessments, rapid and thorough diagnostic evaluation, and prompt initiation of appropriate antimicrobial therapies are essential. The approach to managing transplant recipients with infection in critical care is discussed and common and emerging opportunistic pathogens are reviewed.