Approach to the immunocompromised host with infection in the intensive care unit.
Despite significant advances in the prevention, diagnosis, and treatment of infection in the immunocompromised host, it remains a major cause of morbidity, increased length of stay, total costs, and of course mortality. Intensive care mortality rates are significantly higher among immunocompromised hosts in part due to the higher incidence of infection severity. The superimposition of the compromised host defenses and critical illness makes the detection and management of infections in such patients more difficult, but crucial toward salvaging patient outcome. Moreover, although there is a rapidly increasing evidence base in intensive care medicine, many interventional trials for the management of severe sepsis (activated protein C, adjunctive corticosteroids, goal-based resuscitation), acute lung injury (low stretch ventilation), and other organ failures have excluded immunocompromised hosts.
Linden
Peter K
PK
Department of Critical Care Medicine, University of Pittsburgh Medical Center, Room 602A, Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA. plinden@wpahs.org
D016026:Bone Marrow Transplantation / Q000009:adverse effects; D016638:Critical Illness; D003428:Cross Infection / Q000175:diagnosis* / Q000188:drug therapy*; D015658:HIV Infections; D006801:Humans; D016867:Immunocompromised Host; D009369:Neoplasms / Q000150:complications; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy*; D016377:Organ Transplantation / Q000009:adverse effects