[Infection in intensive care medicine: predisposition, pathogenesis and diagnosis]

Intensive care unit patients are a group with an increased risk for the development of septicemia. The combination of illness (trauma, burn, surgery, metabolic coma etc.) and iatrogenic factors (foreign bodies, ventilation, drugs etc.) make them more susceptible to severe infections. Rapid diagnosis of septicemia is important, since the prognosis is dependent on rapid treatment. Sedation and ventilation may mask the primary symptoms of septicemia, and in these cases the condition is not diagnosed until signs of complications (shock, disseminated intravascular coagulation, multiple organ failure) appear. Aside from clinical observation and laboratory results, hemodynamic symptoms may be indicative of septicemia. In the presence of septic signs, blood, tracheal secretion, urine etc. must be cultivated without delay, before starting empirical treatment. Surveillance cultures may make for more appropriate initial treatment, though they pose the problem of differentiation between colonization and infection.