Critical care clinics
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Necrotizing soft tissue infections (NSTIs) are infrequent yet highly lethal infections, and a high index of suspicion is required for early diagnosis. Diagnosing NSTIs early can be challenging, and knowledge of the available tools is essential to provide appropriate treatment. ⋯ Mortality continues to be high, and delayed surgical treatment is the most important risk factor. For the long-term recovery of patients with NSTI, providing early physiologic and nutritional support and physical rehabilitation is essential.
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Severe malaria is a medical emergency requiring early intervention to prevent death. This article highlights key aspects of the management of severe malaria syndromes in the intensive care unit, with a focus on individual case management of imported malaria. ⋯ In all groups with severe malaria, intravenous artesunate is the antimalarial agent of choice. This article discusses specific antimalarial therapies, optimal supportive management strategies, differences from strategies for bacterial sepsis, and trials of adjunctive therapy for severe malaria in humans.
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Critical care clinics · Oct 2013
ReviewLife-threatening Infections in Medically Immunocompromised Patients.
Chronic medical diseases, such as diabetes, chronic obstructive pulmonary disease, chronic kidney disease, cirrhosis, and heart failure, are associated with various immune defects that make affected patients prone to specific infections. This review discusses the epidemiology, pathogenesis, antimicrobial and surgical management, supportive care, and outcome of life-threatening infections associated with common chronic medical diseases.
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The incidence of candidemia and invasive Candida infections has increased substantially over the last 2 decades. These infections are associated with risk factors that characterize intensive care unit patients. ⋯ Outcomes in the intensive care setting depend on physician awareness and rapid intervention. The epidemiology of the disease, its diagnostic challenges, and management strategies, including prophylactic, preemptive, and definitive therapeutic approaches, are presented herein.
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Vancomycin-resistant enterococci (VRE) consist mainly of Enterococcus faecalis and E faecium, the latter mostly hospital-acquired. In addition, E gallinarum and E casseliflavus are intrinsically vancomycin-resistant and are community-acquired. ⋯ VRE are difficult to treat; therefore, infection control measures in hospitals are of prime importance in preventing the establishment of these pathogens. Most severe VRE infections will need combination therapy because many of the effective antimicrobial agents, when used alone, have only a bacteriostatic effect.