An ongoing dialogue on HIV/AIDS, infectious diseases,
December 13th, 2009
Infection and the ICU: Outcome Predictable, but Important
If you enrolled over 14,000 ICU patients into a study on a single day, and then did follow-up, what would you find regarding the relationship of infection to the outcomes of ICU stay and mortality?
Just such a study was published in JAMA last week, and here are the not-so-stunning conclusions:
Infections are common in patients in contemporary ICUs, and risk of infection increases with duration of ICU stay. In this large cohort, infection was independently associated with an increased risk of hospital death.
To an ID specialist, this is kind of like reading that someone has done a study linking time spent outside in the rain and the likelihood of becoming wet. Patients in ICUs are susceptible to getting infections for innumerable reasons — so many that it seems to us (from our admittedly biased perspective) almost remarkable when an infection doesn’t occur.
In all seriousness, ICU-related infections are a gargantuan problem, and if this study helps publicize the clinical and research needs, more power to it.
2 Responses to “Infection and the ICU: Outcome Predictable, but Important”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
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Dear Sir, Some times in ICU you have an afebrile patient on ventilator without laboratory/clinical evidence of infection-but you no that infection is imminent as a result of aspiration pneumonia and minute reflux, by suction, by equipments and personnels. Do you for these kinds of patients prescribe prophylactic antibiothics or if they were on antibiotics do you discontinue after routine course as other subjects without ventilator support? thanks
If the question is whether I prescribe antibiotics as a preventive to ICU patients with no lab/clinical evidence of infection, the answer is generally no. Some surgical protocols, however, include short courses of antibiotics for these patients.
Paul