Seminars in respiratory infections
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Semin Respir Infect · Dec 2000
ReviewVentilator-associated pneumonia: incidence, risk factors, and microbiology.
Ventilator-associated pneumonia (VAP) is a pulmonary infection that occurs after at least 48 hours of mechanical ventilation (MV). The incidence depends on several factors, although the most important are those related to the host and duration of MV. VAP can be differentiated into early-onset (<5 days) and late-onset types (> or =5 days). ⋯ After 5 days of MV, pathological colonization with gram-negative bacteria may occur, and late-onset VAP is more likely to be attributable to this group of microorganism. Incidence, risk factors, and microbiology depend strongly on the time frame in which the episode develops. However, initial and pathological colonization during the intensive care unit stay can modify this concept.
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Semin Respir Infect · Dec 2000
ReviewInfection control in intensive care units and prevention of ventilator-associated pneumonia.
Ventilator-associated pneumonia (VAP) is considered the most frequent infection in the intensive care unit (ICU), although incidence rates depend on the diagnostic methods. Because VAP has been associated with increased mortality and greater costs for medical care, prevention remains an important goal for intensive care medicine. Selective digestive decontamination (SDD), the most frequently studied method of infection prevention, is still controversial despite more than 30 prospective randomized trials and 6 metaanalyses. ⋯ Among these are the use of endotracheal tubes with the possibility of continuous aspiration of subglottic secretions, oropharyngeal decontamination with antiseptics, or the semirecumbent treatment position of patients. Although these methods were successful in single studies, more data are needed. Notwithstanding the potential benefits of these interventions, such classic infection control measures as handwashing remain the cornerstone of infection prevention.
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Patients with multiple trauma and head injuries are high-risk populations for developing nosocomial infections, which are the first cause of death after 3 weeks of admission. Pneumonia caused by methicillin-sensitive Staphylococcus aureus is the most frequent infection in patients with a decreased level of consciousness. ⋯ The diagnosis of meningitis is difficult because CSF biochemical data are not specific. Patients with spinal cord injuries are at greater risk for developing infections caused by multiresistant microorganisms because of their prolonged hospital stay.