Bacterial Infections in the ICU

Dr. Manjari Joshi is an expert in infectious diseases who works at the Shock Trauma Center in Baltimore, and specializes in battling the rages of hospital associated infections as well as convincing us all that the infiltrate on the chest x-ray is obviously not an infection – and that we just need to do better chest PT on our patients.  This is a great review of the baddest bugs in the ICU, how to treat them, and what we can do to prevent them from taking over our units!!

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Pearls

• We must distinguish an infection vs. non-infection.  The chronology of the patient’s history and course are extraordinarily important.  If the patient was admitted to the ICU with a non-infectious problem, their chance of them developing a new infection < 72 hours is unlikely.  Remember the non-infectious causes of SIRS!!
• Carbapenem-resistant enterobacteriaceae (CRE): Dangerous bugs found not only in healthcare facilities, but moving into the community.  The most common organism is Klebsiella sp.  Diagnose a CRE by asking your lab to perform a “Modified Hodge Test”
• Positive blood cultures with S. Aureus, S. pneumoniae, Enterobacteriaceae, P. aeruginosa, & C. Albicans are almost always real, and should be aggressively treated.
• Bacterial colonization of urinary catheters is quite common.  There is no evidence that changing regularly changing the foley decreases risk of infections, except if it is colonized with yeast.
• In some areas of the US, clostridium difficile has caused more deaths than MRSA!  Be mindful of starting unnecessary ABx.  Antibiotics most associated with C. Diff – Clindamycin > fluoroquinolones > carbapenems > cephalosporings > PCNs
• Don’t mess with MRSA.

Another great talk reminding us about the importance of antibiotic stewardship and the increasing amount of resistance in and outside of our ICUs.  So practice carefully, or the next thing you know – our pets will end up with c. diff!