Abstract
Infectious complications, particularly in the respiratory tract of critically ill patients, are related to increased mortality. Severe infection is part of a multiple system illness and female patients with severe sepsis have a worse prognosis compared to males. Kallistatin is a protective hormokine released during monocyte activation and low levels in the setting of septic shock can predict adverse outcomes. Presepsin is another biomarker that was recently evaluated and is elevated in patients with severe sepsis patients at risk of dying. The Centers for Disease Control and Prevention has introduced new definitions for identifying patients at risk of ventilator-associated complications (VACs), but several other conditions, such as pulmonary edema and acute respiratory distress syndrome, may cause VACs, and not all patients with VACs may have ventilator-associated pneumonia. New studies have suggested strategies to identify patients at risk for resistant pathogen infection and therapies that optimize efficacy, without the overuse of broad-spectrum therapy in patients with healthcare-associated pneumonia. Innovative strategies using optimized dosing of antimicrobials, maximizing the pharmacokinetic and pharmacodynamic properties of drugs in critically ill patients, and newer routes of drug delivery are being explored to combat drug-resistant pathogens. We summarize the major clinical studies on respiratory infections in critically ill patients published in 2013.
Highlights
Ill patients with respiratory infections have been the continued focus of investigation over the last several years
Maruyama and colleagues [23], in a prospective study of 425 patients (CAP = 124, healthcare-associated pneumonia (HCAP) = 321), applied a therapeutic algorithm based on the presence of multi-drug resistant (MDR) risk factors and severity of illness to determine its impact on outcomes
Severe infection is part of a multiple system illness, and some recent data have examined the relationship of pneumonia to cognitive impairment, showing that infection can lead to cognitive decline, possibly related to inflammatory cytokines, while at the same time patients who develop pneumonia may be more cognitively impaired than those without pneumonia
Summary
Ill patients with respiratory infections have been the continued focus of investigation over the last several years. Hayashi and colleagues [16] compared 153 patients with VACs to 390 without VACs and noted that patients who developed VACs had a longer ICU LOS (22 versus 11 days), duration of MV (20 versus 5 days) and use of antibiotics but no difference in overall ICU mortality and hospital LOS.
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