Catheter related infections (Paiva)
CVCBSI is a problem not just inside the ICU but also outside
Risk factors
- Non-alcoholic antiseptic solution
- Femoral site
- Duration of catheterisation
- Trauma/immunocompromised pt
- Medical cause of admission
Use a bundle approach for CVCBSI prevention
Clinical findings are unreliable for the diagnosis of CVCBSI; you need blood cultures from CVC and peripherally
Minimum duration of antibiotics for CVCBSI is 14 days
Daptomycin is an alternative for vancomycin with a safer side effect profile
References
Ventilator-Associated Pneumonia (Martin-Loeches)
VAP accounts for he vast majority of ICU HAP which is associated with increased morbidity and mortality
Risk of VAP highest in the first week of mechanical ventilation
Know your local pathogens and hence the appropriate antibiotic treatment
If you suspected VAP, get the microbiological sample!
References
Latest CDC definitions for VAP
ECDC Guidelines for management of HAP and VAP
Fungal Infections in ICU (Eggimann)
Rate of candidaemia is 10 times greater on ICU compared to general hospital patient
Invasive candidiasis may take up to 7-14 days of exposure before developing
40-80% of ICU patients would be colonised by colonised but only 1-10% would develop systemic infection. The challenge is to decide who gets empirical antifungal?
Consider use of Candida Score and discuss with colleagues
References
Prevention of invasive candidaemia
Treatment strategies for candidiasis