Infectious diseases in the critically ill patients

Area of Science:

• Critical care medicine
• Infectious diseases
• Clinical pharmacology

Background:

• Infections affect over half of intensive care unit (ICU) patients, necessitating antimicrobial therapy in most.
• Infections significantly increase ICU mortality and contribute substantially to healthcare costs.
• Antimicrobial resistance is a major challenge in critically ill patients, complicating treatment decisions.

Purpose of the Study:

• To review common infections in critically ill patients.
• To discuss antimicrobial resistance patterns relevant to critical care.
• To explore pharmacokinetic alterations in critical illness and their impact on drug dosing.

Main Methods:

• Review of contemporary antimicrobial resistance concerns.
• Discussion of pharmacokinetic changes in critical illness.
• Examination of specific infections including ventilator-associated pneumonia, fungal infections, C. difficile, UTIs, and bloodstream infections.

Main Results:

• High prevalence of infections and antimicrobial use in ICUs.
• Significant impact of infections on mortality and costs.
• Numerous resistance challenges including MRSA, VRE, ESBLs, MDR Gram-negatives, and fungal resistance.

Conclusions:

• Critical illness profoundly impacts pharmacokinetics, affecting drug absorption, distribution, metabolism, and excretion.
• Effective management of infections in critically ill patients demands consideration of resistance patterns and altered pharmacokinetics.
• Evidence-based guidelines and specific disease considerations are crucial for optimizing pharmacotherapy in the ICU.