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Diagnosis, prevention, and treatment of device-related infection in the ICU 

Diagnosis, prevention, and treatment of device-related infection in the ICU
Chapter:
Diagnosis, prevention, and treatment of device-related infection in the ICU
Author(s):

Walter Zingg

and Stephan Harbarth

DOI:
10.1093/med/9780199600830.003.0288
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date: 21 February 2020

Many patients in the intensive care unit (ICU) suffer from health care-associated infections. Age, immunosuppression, neutropenia, or multi-organ failure are preconditions, but health care-associated infections are largely related to the use of medical devices. Breaches of aseptic technique are the most important risk factor. Central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections represent up to 75% of all health care-associated infections in the ICU. Ease of diagnosis and effective prevention strategies make the central line-associated bloodstream infection a model of how to diagnose, treat, and prevent health care-associated infections. Identification of ventilator-associated pneumonia is less straightforward and suffers from inconsistent definitions, making surveillance and benchmarking difficult. Catheter-associated urinary tract infection is underestimated in the ICU because clinical signs cannot be assessed in sedated patients. Antibiotic overuse in the ICU selects for multidrug-resistant micro-organisms and thus, broad-spectrum antibiotics must be used to offer empiric treatment of health care-associated infections. Accurate microbiology testing aiming at isolating causative micro-organisms is key to de-escalate antibiotic therapy. Health care-associated infections are preventable, many factors. Successful prevention programmes offer a comprehensive protocol, follow a multidisciplinary approach in preparation, and a multimodal training and education programme in implementation.

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