NOSOCOMIAL INFECTION
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1. Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin Microbiol Rev. 2006 Oct;19(4):637-57. Pulmonary and Critical Care Medicine, P.O. Box 800546, UVa HS, Charlottesville, VA 22908, USA. truwit@virginia.edu While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algorithm for the bedside clinician and also focuses on the controversies with regard to diagnostic tools and approaches, treatment plans, and prevention strategies. 2. Ortiz R, Lee K. Nosocomial infections in neurocritical care. Curr Neurol Neurosci Rep. 2006 Nov;6(6):525-30. Review. Department of Neurology, Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, USA. Development of nosocomial infections is a commonly encountered problem for critically ill patients. Approximately half of all nosocomial pneumonias in the neurointensive care unit (NICU) are associated with ventilator-associated pneumonia. Prompt diagnosis with appropriate specimen analysis is required in order to prevent increased morbidity. Catheter-related blood stream infection imposes financial as well as medical implications. Multifaceted interventions are helpful to ensure adherence with evidence-based infection control guidelines. Urosepsis occurs in approximately 16% of patients. Colonized patients without evidence of infection do not require treatment, but the indwelling catheter should be changed. NICU patients have increased risk of developing cerebrospinal fluid infection due to frequent placement of external ventricular drains. The incidence of ventriculostomy-related meningitis or ventriculitis is approximately 8%. It is unclear whether the duration of ventricular catheter has any relationship with the risk of infection. Patients often receive multiple antibiotics, leading to an increased risk of developing Clostridium difficile colitis, which needs prompt diagnosis and appropriate antimicrobial therapy. Therapy: 15480. Bonacorsi S, Farnoux C, Bidet P, Caro V, Aizenfisz S, Benhayoun M, Aujard Y, Guiso N, Bingen E. Treatment failure of nosocomial pertussis infection in a very-low-birth-weight neonate. J Clin Microbiol. 2006 Oct;44(10):3830-2. 15481. Kallel H, Bahloul M, Hergafi L, Akrout M, Ketata W, Chelly H, Hamida CB, Rekik N, Hammami A, Bouaziz M. Colistin as a salvage therapy for nosocomial infections caused by multidrug-resistant bacteria in the ICU. Int J Antimicrob Agents. 2006 Oct;28(4):366-9.
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