Infection in the critically ill surgical patient

After surgery, critically ill patients in the intensive care unit (ICU) may acquire infections which differ from those acquired elsewhere with regard to the anatomical site involved and the causative micro-organisms. Specific risk factors for infection in the ICU have been shown to be associated with exposure to invasive devices and the use of broad-spectrum antibiotic treatment. Control of infection depends on the timely suspicion of its presence and the identification of the potential anatomical source of infection. Furthermore, the collection of adequate fluid samples for cultures before any anti-microbial treatment is introduced is paramount in order to identify responsible microbes correctly and to re-adjust therapy subsequently. It should be stressed that, when empirical anti-microbial therapy is started before micro-organism identification, the initial treatment will be appropriate only in half of the cases. Gram-negative bacteria of the Pseudomonas aeruginosa and Enterobacter cloaca strains remain the leading cause of nosocomial infection in the ICU. Other pathogens which have caused concern in ICU patients over the past decade are Staphylococcus aureus and fungal infection mainly of theCandida spp. This chapter reviews the more common infections encountered in the high-risk surgical patients in the ICU according to the anatomical localization of the infection, i.e. respiratory, abdominal, urinary, wound and bloodstream infections.