How to treat infections in a surgical intensive care unit.

Jan De Waele,Liesbet De Bus

doi:10.1186/1471-2334-14-193

Abstract

The management of infections in surgical intensive care unit patients poses specific challenges. Although the overall approach to the patient is no different from other patients, diagnosis is often problematic. As in other infections, multidrug resistance is increasingly described, and changes in pharmacokinetics may require different dosing strategies. Also the need for source control adds a level of complexity to the management of the patient. Whereas source control was a purely surgical issue before, percutaneous drainage has emerged as an important alternative. Appropriate timing of source control often remains difficult to determine, but in most severe infections source control should not be delayed. But also the need for a multidisciplinary approach can make the decision making difficult. New concepts such as dedicated source control teams may further assist in selecting the most appropriate treatment strategy and further improve outcome of surgical severe sepsis patients.

Highlights

Severe infections in surgical patients may be the reason for admission in some, but may develop during intensive care unit (ICU) stay in others
Epidemiology of infections in surgical ICU patients SICU patients apparently are at the highest risk to be diagnosed with an infection, presumably because the infection itself was the cause for admission to the ICU more often; as an example, in the Sepsis Occurrence in Acutely ill Patients (SOAP) study, 89% of the abdominal infections were non-ICU acquired [3], the highest percentage of frequently encountered infections studied
In a large study from China, abdominal infections accounted for 72 percent of the infections in SICU patients diagnosed with severe sepsis, with acute pancreatitis and gastrointestinal perforation as the leading sources of infection [1]

Summary

Introduction

Severe infections in surgical patients may be the reason for admission in some, but may develop during intensive care unit (ICU) stay in others. Diagnosing infections in surgical ICU patients Typically, SICU patients with infectious complications are either admitted with an infection (mostly postoperative) or they develop it during their admission for another primary diagnosis Both categories pose specific problems in terms of timely diagnosis to allow early therapy. In a prospective multicenter study, Van Ruler et al found that – contrary to what one may think – the extent of peritonitis, the source of the infection, the type of contamination or operative variables such as the presence of an anastomosis, were not associated with recurrent infection Adding postoperative symptoms such as fever and parameters of organ dysfunction to the multivariate model, could identify patients requiring additional source control measures [5]. Source control interventions may include surgery and other measures can be – initially – adequate such as PCD or removal of infected tissues or devices

As soon as patient

No residual infection

Findings

Conclusions