Critical Care Refresher Course: Infection and Inflammation

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


Matching Michigan

Bundles for CVC management

Chlorhexidine bath


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!


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


Prevention of invasive candidaemia

Treatment strategies for candidiasis

Who to start empirical antifungals?

Candida score