Infectious disease clinics of North America
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Infect. Dis. Clin. North Am. · Sep 2009
ReviewCentral nervous system infections: meningitis and brain abscess.
Despite advances in antimicrobial and antiviral therapy, meningitis and brain abscess are infections that result in significant morbidity and mortality. A multidisciplinary approach, including intensive care, is often required in the treatment of these infections. ⋯ Brain abscess is a focal infection of the brain parenchyma, commonly caused by bacterial, fungal, and parasitic pathogens. This article reviews the common infectious etiologies of central nervous system infections, especially bacterial meningitis and brain abscess, and their subsequent management in the intensive care unit.
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Infect. Dis. Clin. North Am. · Sep 2009
ReviewIntra-abdominal sepsis: newer interventional and antimicrobial therapies.
Complicated intra-abdominal infections are the second most common cause of septic death in the intensive care unit. Although there have been improvements in the outcome of sepsis regardless of etiology, this is even more striking for intra-abdominal infections. From observation, recent advances in interventional techniques, including more aggressive use of percutaneous drainage of abscesses and use of "open abdomen" techniques for peritonitis, have significantly affected the morbidity and mortality of physiologically severe complicated intra-abdominal infection.
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The diagnosis and management of severe sepsis and septic shock is a complex and dynamic process. Newer evidence-based interventions are constantly being developed and implemented with the purpose of improving morbidity and mortality. Current investigations are being performed in hospital environments to determine the change in behaviors and clinical impact with the most recent recommendations. The use of standardized treatment protocols in addition to newer diagnostic and treatment modalities in patients who have severe sepsis and septic shock can continue to improve patient-related outcomes and the damaging effect of these diseases on society.
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Hospital-acquired infections (HAI) occur in 5%-10% of patients admitted to hospitals in the United States, and HAIs remain a leading cause of morbidity and mortality. Patients admitted to ICUs account for 45% of all hospital-acquired pneumonias and bloodstream infections (BSIs), although critical care units comprise only 5% to 10% of all hospital beds. The severity of underlying disease, invasive diagnostic and therapeutic procedures that breach normal host defenses, contaminated life-support equipment, and the prevalence of resistant microorganisms are critical factors in the high rate of infection in the ICUs. This article discusses the clinical importance of BSI, including hospital- and community-acquired episodes in the ICU.
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Infect. Dis. Clin. North Am. · Sep 2009
ReviewClostridium difficile infection in the intensive care unit.
Clostridium difficile infection (CDI) is becoming more common worldwide. The morbidity and mortality associated with C difficile is also increasing at an alarming rate. ⋯ Treatment of C difficile continues to be a difficult problem in patients with severe or recurrent disease. This article seeks to provide a broad understanding of CDI in the intensive care unit, with special emphasis on risk factor identification, treatment options, and disease prevention.