ICU · ICU-acquired infection
ICU-Acquired Infection — VAP, CRBSI and CLABSI
Also known as Ventilator-associated pneumonia · VAP · Catheter-related bloodstream infection · CRBSI · Central line infection · Nosocomial infection · Catheter-associated UTI
The ICU-acquired infections are the complications of the critical care itself — the ventilator-associated pneumonia (the VAP), the catheter-related bloodstream infection (the CRBSI), the catheter-associated UTI, and the Clostridioides difficile. Each increases the mortality, the length of stay, and the cost, and each is largely PREVENTABLE through the bundles. This topic builds the examiner's framework on the VAP (the diagnosis, the prevention bundle, the short-course antibiotics), the CRBSI (the prevention, the diagnosis, the catheter removal), and the general principles of the infection prevention in the ICU.
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Meet the patient
A 65-year-old man has been ventilated for six days for severe ARDS. The nurse calls you at 3am: new fever, purulent secretions, rising FiO2 requirement, and a new infiltrate in the right lower lobe. His central line has been in for eight days. The question is not 'is this VAP or CRBSI?' — it is 'what in my own practice let this happen, and how do I stop the next one?'.[1]
Every ICU-acquired infection is a device complication we inflict. The ventilator, the central line, the urinary catheter — each is a highway for bacteria into a sterile site, and day bundle is not done is day line infects. Prevention beats treatment, and the bundle done every time beats the clever antibiotic.[1]
References20ShowHide
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- [2]O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections Clin Infect Dis, 2011.PMID 21460264
- [3]Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update Infect Control Hosp Epidemiol, 2014.PMID 25026607
- [4]Kalil AC, Metersky ML, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society Clin Infect Dis, 2016.PMID 27418577
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- [9]Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017 JAMA Surg, 2017.PMID 28467526
- [10]Johnson S, Lavergne V, Skinner AM, et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults Clin Infect Dis, 2021.PMID 34164674
- [11]Louie TJ, Miller MA, Mullane KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection N Engl J Med, 2011.PMID 21288078
- [12]Wilcox MH, Gerding DN, Poxton IR, et al. Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection N Engl J Med, 2017.PMID 28121498
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- [14]Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America Clin Infect Dis, 2009.PMID 19489710
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- [16]Klompas M, Branson R, Cawcutt K, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update Infect Control Hosp Epidemiol, 2022.PMID 35589091
- [17]Culver DH, Horan TC, Gaynes RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System Am J Med, 1991.PMID 1656747
- [18]Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Crit Care Med, 2018.PMID 30113379
- [19]Zhao T, Wu X, Zhang Q, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia Cochrane Database Syst Rev, 2020.PMID 33368159
- [20]Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial Lancet, 2008.PMID 18191684