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Management of Unique Pneumonias Seen in the Intensive Care Unit
Infection of the lower respiratory tract is a potentially severe or life-threatening illness. Taking the right steps to recognize, identify, and treat pneumonia is critical to improving patient outcomes. An awareness of the diversity of potential infectious causes, the local endemic flora and resistance patterns, as well as testing strategies to differentiate causes of pneumonia is essential to providing the best patient outcomes. Understanding surveillance definitions allow intensivists to become partners in reducing hospital-associated infections and improving quality of care. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Authors: Brooke K. Decker, LaToya A. Forrester, David K. Henderson Source Type: research

Uses of Procalcitonin as a Biomarker in Critical Care Medicine
Procalcitonin is a commonly used biomarker for infection and severity in the intensive care unit. Although relatively specific for bacterial, as opposed to viral, infections, serum procalcitonin levels also correlate with disease severity and thus cannot reliably distinguish between bacterial and nonbacterial infections in the setting of critical illness, particularly in cases of severe influenza and coronavirus disease-2019. Baseline procalcitonin levels are insufficiently discriminative to permit the withholding of antibiotics in patients with critical illness and suspected sepsis. Trends in procalcitonin levels over tim...
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Authors: Ryan C. Maves, Chukwunyelu H. Enwezor Source Type: research

Management of Common Postoperative Infections in the Surgical Intensive Care Unit
Postoperative infection and sepsis in the surgical intensive care unit (SICU) are common problems, and can be the reason for SICU admission or can be acquired during the SICU stay. Both diagnosis and management of infection and sepsis in the SICU can be complex, related to the surgical procedures performed, patient comorbidities, and resistant pathogens. The need for “source control” of postoperative infections can pose specific challenges and significant complexity in patient management. Postoperative infections in the SICU are associated with increased morbidity, mortality, and resource utilization, and therefore a s...
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Authors: Staci T. Aubry, Lena M. Napolitano Source Type: research

Severe Clostridioides difficile Infection in the Intensive Care Unit —Medical and Surgical Management
Clostridioides difficile remains a major cause of morbidity and mortality in the intensive care unit, and therefore, C difficile guidelines are frequently being updated. Currently, fidaxomicin is the suggested treatment of initial and recurrent infection. Oral vancomycin is an acceptable alternative, followed by rifaximin and fecal microbiota transplantation. Bezlotoxumab is suggested in recurrent cases within 6  months. If patients fail to improve within 3 to 5 days of therapy, especially in patients who have had nasogastric tubes or emergent surgery, fulminant colitis is possible and surgical consultation should be con...
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Authors: Ramzy Husam Rimawi, Stephanie Busby, Wendy Ricketts Greene Source Type: research

ICU Management of Invasive β-Hemolytic Streptococcal Infections
β-hemolytic streptococci (BHS) are a leading cause of invasive bacterial disease worldwide. They are subtyped based on the presence of the surface polysaccharide antigens and include Group A Streptococcus (GAS; Streptococcus pyogenes), Group B Streptococcus (GBS; Streptococcus agalactiae), and non- group A, non-group B Streptococci (NABS). Invasive BHS infection is defined as isolation from the normally sterile site in patients with a compatible clinical syndrome which include, but is not limited to, streptococcal toxic shock syndrome (STSS), Necrotizing soft tissue infection (NSTI), bacteremi a, meningitis lower respirat...
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Authors: Ahmed Babiker, Sameer S. Kadri Source Type: research

Timing and Spectrum of Antibiotic Treatment for Suspected Sepsis and Septic Shock
Sepsis guidelines and mandates encourage increasingly aggressive time-to-antibiotic targets for broad-spectrum antimicrobials for suspected sepsis and septic shock. This has caused considerable controversy due to weaknesses in the underlying evidence and fear that overly strict antibiotic deadlines may harm patients by perpetuating or escalating overtreatment. Indeed, a third or more of patients currently treated for sepsis and septic shock have noninfectious or nonbacterial conditions. These patients risk all the potential harms of antibiotics without their possible benefits. Updated Surviving Sepsis Campaign guidelines n...
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Authors: Theodore R. Pak, Chanu Rhee, Michael Klompas Source Type: research

Preparing the Intensive Care Unit for a Lethal Viral Respiratory Pandemic
Future pandemics will certainly arise and continue to have a profound impact on health care, including management within the intensive care unit. Robust preparedness plans require specific attention to detail as it pertains to incident management, surge capacity, infection control practices, and the health care workforce. The COVID-19 pandemic highlighted many gaps in prior preparedness efforts, and those lessons learned must be integrated into updated preparedness work. Additionally, ensuring health care workforce wellness, decreasing health care disparities, strengthening networks for rapid research and response, and act...
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Authors: Kelly Cawcutt, Andre C. Kalil, Angela Hewlett Source Type: research

Management of Highly Resistant Gram-Negative Infections in the Intensive Care Unit in the Era of Novel Antibiotics
Antimicrobial-resistant bacterial infections, particularly those caused by Gram-negative bacteria, are major public health threats globally. Since 2015, several antibiotics with activity against highly antimicrobial-resistant Gram-negative bacteria have been approved, which offer alternatives emerging to previous frontline agents such as polymyxins and aminoglycosides. Despite data that new drugs are more effective and better tolerated than older agents against at least some highly antimicrobial-resistant Gram-negative bacterial infections, clinicians remain uncertain about how best to incorporate them into clinical practi...
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Authors: Cornelius J. Clancy, Minh Hong Nguyen Source Type: research

Infections in the Critically Ill  during the COVID-19 Pandemic: Infectious Diseases on Steroids
The first issue of “Complex Infectious Diseases Issues in the Intensive Care Unit” in Infectious Disease Clinics of North America highlighted the overwhelming presence of infection in the intensive care unit (ICU) and the unique intersection of infectious disease and critical care medicine. Now, 5 years later, the COVID-19 pandemic has highlighted the intersection of these two subspecialties in an obvious way and has made abundantly clear that the partnership should be strengthened. The second issue of “Update on Complex Infectious Diseases Issues in the Intensive Care Unit” is a compilation of articles that combin...
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Authors: Sameer S. Kadri, Naomi P. O'Grady Source Type: research

Update on Complex Infectious Diseases Issues in the Intensive Care Unit
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Authors: Sameer S. Kadri, Naomi P. O ’Grady Source Type: research

Copyright
Elsevier (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Source Type: research

Contributors
HELEN W. BOUCHER, MD, FIDSA, FACP (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Source Type: research

Contents
Sameer S. Kadri and Naomi P. O'Grady (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Source Type: research

Forthcoming Issues
Infections in Older Adults (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - November 1, 2022 Category: Infectious Diseases Source Type: research

Early Disseminated Lyme Disease
Early disseminated Lyme disease can involve the peripheral or central nervous system, but with early diagnosis and treatment, prognosis for full recovery is excellent. The typical clinical presentations of neuroborreliosis are highlighted, and an approach to diagnosis and treatment is described. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - September 1, 2022 Category: Infectious Diseases Authors: Tyler Crissinger, Kelly Baldwin Source Type: research