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[Nosocomial infections: back to the future]
1Istituto di Clinica delle Malattie Infettive, Azienda Ospedaliera di Perugia.
Abstract:
The increasing rate of nosocomial infections seems to be related to the wider use of invasive procedures. Evaluation of the patient risk factors for infection, use of SIRS classification and knowledge of the setting care should be utilized for the diagnostic approach. The empiric antibiotic therapy should take in account the site of the infection (bacteremia, pneumonia, urinary tract infection etc.) and the presumed pathogen; knowledge of the local epidemiology is a pre-requisite for the antibiotics choice. Among gram-positive microorganisms, methicillin-resistant staphylococci and vancomycin-resistant enterococci are responsible of difficult to treat infections; penicillin-resistant pneumococci, largely present in some european countries, might become an emerging pathogen also in Italy. The knowledge and ability of infectious diseases specialist encompasses clinical, microbiological and epidemiological fields to play a key role in the prevention and management of nosocomial infections.
Insights
Nosocomial infections are rising due to invasive procedures. Effective management requires assessing patient risks, using Systemic Inflammatory Response Syndrome (SIRS) criteria, and understanding local epidemiology for antibiotic selection.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Context:
- Rising rates of nosocomial infections linked to increased invasive procedures.
- Need for structured diagnostic approaches considering patient risk factors and care settings.
- Emergence of antibiotic-resistant pathogens poses significant treatment challenges.
Purpose:
- To outline a diagnostic and therapeutic strategy for managing nosocomial infections.
- To emphasize the importance of local epidemiological data in guiding antibiotic therapy.
- To highlight the critical role of infectious disease specialists in combating hospital-acquired infections.
Summary:
- Nosocomial infections necessitate evaluating patient risk factors and utilizing Systemic Inflammatory Response Syndrome (SIRS) classification.
- Empiric antibiotic therapy must consider infection site, presumed pathogen, and local epidemiology.
- Key resistant pathogens include methicillin-resistant staphylococci, vancomycin-resistant enterococci, and penicillin-resistant pneumococci.
Impact:
- Improved diagnostic accuracy and appropriate antibiotic selection can reduce treatment failures.
- Enhanced understanding of local epidemiology aids in combating resistant bacterial strains.
- Infectious disease specialists are crucial for preventing and managing complex nosocomial infections.