Infectious Diseases in Critical Care Medicine INFECTIOUS DISEASE AND THERAPY Series Editor Burke A Cunha Winthrop-University Hospital Mineola, New York and State University of New York School of Medicine Stony Brook, New York Parasitic Infections in the Compromised Host, edited by Peter D Walter and Robert M Genta Nucleic Acid and Monoclonal Antibody Probes: Applications in Diagnostic Methodology, edited by Bala Swaminathan and Gyan Prakash Opportunistic Infections in Patients with the Acquired Immunodeficiency Syndrome, edited by Gifford Leoung and John Mills Acyclovir Therapy for Herpesvirus Infections, edited by David A Baker The New Generation of Quinolones, edited by Clifford Siporin, Carl L Heifetz, and John M Domagala Methicillin-Resistant Staphylococcus aureus: Clinical Management and Laboratory Aspects, edited by Mary T Cafferkey Hepatitis B Vaccines in Clinical Practice, edited by Ronald W Ellis The New Macrolides, Azalides, and Streptogramins: Pharmacology and Clinical Applications, edited by Harold C Neu, Lowell S Young, and Stephen H Zinner Antimicrobial Therapy in the Elderly Patient, edited by Thomas T Yoshikawa and Dean C Norman 10 Viral Infections of the Gastrointestinal Tract: Second Edition, Revised and Expanded, edited by Albert Z Kapikian 11 Development and Clinical Uses of Haemophilus b Conjugate Vaccines, edited by Ronald W Ellis and Dan M Cranoff 12 Pseudomonas aeruginosa Infections and Treatment, edited by Aldona L Battch and Raymond P Smith 13 Herpesvirus Infections, edited by Ronald Glaser and James F Jones 14 Chronic Fatigue Syndrome, edited by Stephen E Straus 15 Immunotherapy of Infections, edited by K Noel Masihi 16 Diagnosis and Management of Bone Infections, edited by Luis E Jauregui 17 Drug Transport in Antimicrobial and Anticancer Chemotherapy, edited by Nafsika H Georgopapadakou 18 New Macrolides, Azalides, and Streptogramins in Clinical Practice, edited by Harold C Neu, Lowell S Young, Stephen H Zinner, and Jacques F Acar 19 Novel Therapeutic Strategies in the Treatment of Sepsis, edited by David C Morrison and John L Ryan 20 Catheter-Related Infections, edited by Harald Seifert, Bernd Jansen, and Barry M Farr 21 Expanding Indications for the New Macrolides, Azalides, and Streptogramins, edited try Stephen H Zinner, Lowell S Young, Jacques F Acar, and Harold C Neu 22 Infectious Diseases in Critical Care Medicine, edited by Burke A Cunha 23 New Considerations for Macrolides, Azalides, Streptogramins, and Ketolides, edited by Stephen H Zinner, Lowell S Young, Jacques F Acar, and Carmen Ortiz-Neu 24 Tickborne Infectious Diseases: Diagnosis and Management, edited by Burke A Cunha 25 Protease Inhibitors in AIDS Therapy, edited by Richard C Ogden and Charles W Flexner 26 Laboratory Diagnosis of Bacterial Infections, edited by Nevio Cimolai 27 Chemokine Receptors and AIDS, edited by Thomas R O’Brien 28 Antimicrobial Pharmacodynamics in Theory and Clinical Practice, edited by Charles H Nightingale, Takeo Murakawa, and Paul G Ambrose 29 Pediatric Anaerobic Infections: Diagnosis and Management, Third Edition, Revised and Expanded, Itzhak Brook 30 Viral Infections and Treatment, edited by Helga Ruebsamen-Waigmann, Karl Deres, Guy Hewlett, and Reinhotd Welker 31 Community-Aquired Respiratory Infections, edited by Charles H Nightingale, Paul G Ambrose, and Thomas M File 32 Catheter-Related Infections: Second Edition, edited by Harald Seifert, Bernd Jansen, and Barry Farr 33 Antibiotic Optimization: Concepts and Strategies in Clinical Practice (PBK), edited by Robert C Owens, Jr., Charles H Nightingale, and Paul G Ambrose 34 Fungal Infections in the Immunocompromised Patient, edited by John R Wingard and Elias J Anaissie 35 Sinusitis: From Microbiology To Management, edited by Itzhak Brook 36 Herpes Simplex Viruses, edited by Marie Studahl, Paola Cinque and Toms ăm Bergstro 37 Antiviral Agents, Vaccines, and Immunotherapies, Stephen K Tyring 38 Epstein-Barr Virus, edited by Alex Tselis and Hal B Jenson 39 Infection Management for Geriatrics in Long-Term Care Facilities, Second Edition, edited by Thomas T Yoshikawa and Joseph G Ouslander 40 Infectious Diseases in Critical Care Medicine, Second Edition, edited by Burke A Cunha 41 Infective Endocarditis: Management in the Era of Intravascular Devices, edited by John L Brusch 42 Fever of Unknown Origin, edited by Burke A Cunha 43 Rickettsial Diseases, edited by Didier Raoult and Philippe Parola 44 Antimicrobial Pharmacodynamics in Theory and Clinical Practice, Second Edition, edited by Charles H Nightingale, Paul G Ambrose, George L Drusano, and Takeo Murakawa 45 Clinical Handbook of Pediatric Infectious Disease, Third Edition, Russell W Steele 46 Anaerobic Infections: Diagnosis and Management, Itzhak Brook 47 Diagnosis of Fungal Infections, edited by Johan A Maertens and Kieren A Marr 48 Antimicrobial Resistance: Problem Pathogens and Clinical Countermeasures, edited by Robert C Owens, Jr and Ebbing Lautenbach 49 Lyme Borreliosis in Europe and North America, edited by, Sunil Sood 50 Laboratory Diagnosis of Viral Infections, Fourth Edition, edited by Keith R Jerome 51 Infectious Diseases in Critical Care Medicine, Third Edition, edited by Burke A Cunha Infectious Diseases in Critical Care Medicine Third Edition Edited by Burke A Cunha Winthrop-University Hospital Mineola, New York, USA State University of New York School of Medicine Stony Brook, New York, USA Informa Healthcare USA, Inc 52 Vanderbilt Avenue New York, NY 10017 # 2010 by Informa Healthcare USA, Inc Informa Healthcare is an Informa business No claim to original U.S Government works Printed in the United States of America on acid-free paper 10 International Standard Book Number-10: 1-4200-9240-5 (hardcover : alk paper) International Standard Book Number-13: 978-1-4200-9240-0 (hardcover : alk paper) This book contains information obtained from authentic and highly regarded sources Reprinted material is quoted with permission, and sources are indicated A wide variety of references are listed Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequence of their use No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers For permission to photocopy or use material electronically from this work, please access www.copyright.com (http:// www.copyright.com/) or contact the Copyright Clearance Center, Inc (CCC) 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400 CCC is a not-for-profit organization that provides licenses and registration for a variety of users For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe Library of Congress Cataloging-in-Publication Data Infectious diseases in critical care medicine / edited by Burke A Cunha – 3rd ed p ; cm — (Infectious disease and therapy ; 51) Includes bibliographical references and index ISBN-13: 978-1-4200-9240-0 (hardcover : alk paper) ISBN-10: 1-4200-9240-5 (hardcover : alk paper) Nosocomial infections Critical care medicine Intensive care units I Cunha, Burke A II Series: Infectious disease and therapy ; 51 [DNLM: Communicable Diseases—diagnosis Communicable Diseases—therapy Critical Care Diagnosis, Differential Intensive Care Units W1 IN406HMN v.51 2009 / WC 100 I4165 2009] RC112.I4595 2009 616.90 0475—dc22 2009022304 For Corporate Sales and Reprint Permissions call 212-520-2700 or write to: Sales Department, 52 Vanderbilt Avenue, 7th floor, New York, NY 10017 Visit the Informa Web site at www.informa.com and the Informa Healthcare Web site at www.informahealthcare.com for Marie Peerless wife and mother, Provider of domestic peace and tranquility, Paragon of truth and beauty, Paradigm of earthly perfection With gratitude for her love and constant support Foreword In the United States during the 1950s, the development of mechanical ventilation led to the organization of special units in hospitals, where health care personnel with specific expertise could efficiently focus on patients with highly technical or complex needs Over the ensuing years the sickest patients as well as those needing mechanical ventilation were grouped into special care units In 1958, Baltimore City Hospital developed the first multidisciplinary intensive care unit The concept of physician coverage 24 hours a day, seven days a week became a logical approach to providing optimal care to the sickest, most complex patients Now, 50 years after the first multidisciplinary intensive care unit was opened, there are now 5000 to 6000 intensive care units in the United States: Over 4000 hospitals offer one or more critical care units, and there are 87,000 intensive care unit beds Critical care represents 13.3% of hospital costs, totaling over $55 billion per year Health care providers are well aware of the role that infections play in the intensive care unit A substantial number of patients are admitted to the intensive care unit because of an infection such as pneumonia, meningitis, or sepsis A substantial number of patients admitted to intensive care units for noninfectious disorders develop infections during their stay Thus, intensivists need expertise in the diagnosis, treatment, and prevention of infectious diseases Management of infections is pivotal to successful outcomes In this third edition of Infectious Diseases in Critical Care Medicine, Burke Cunha has organized 31 chapters into an exceedingly practical and useful overview Providers often find it surprisingly difficult to distinguish infectious and noninfectious syndromes, especially when patients have life-threatening processes that evoke similar systemic inflammatory responses Part I and Part II provide many clinical pearls that help with diagnosis and with developing a strategy for initial patient management Specific chapters focus on special intensive care unit problems, such as central venous catheter infections, nosocomial pneumonias, endocarditis, and Clostridium difficile infection Particularly useful are chapters on special populations that many clinicians rarely encounter: tropical diseases, cirrhosis, burns, transplants, or tuberculosis Chapters on therapy also provide practical advice focused on critically ill patients, in whom choice of agent, toxicities, drug interactions, and pharmacokinetics may be substantially different from patients who are less seriously ill Critical care medicine is becoming more and more technology based Genomics and proteomics can predict susceptibility to various diseases and drug metabolic problems Patients can be assessed by ultrasonography to supplement physical examination Diagnostic biopsies can be performed on virtually any organ Invasive arterial and venous monitoring as well as monitoring of central nervous system and cardiac activity is commonplace Despite these advances in technology, knowledge of differential diagnosis, natural history, and therapeutic options is still essential To understand these processes, Burke Cunha has assembled an impressive team of experienced clinicians to provide insight into the infectious challenges of critical care medicine This edition continues to provide relevant, current information that will enhance clinical practice with this growing segment of hospitalized patients Henry Masur Department of Critical Care Medicine Clinical Center National Institutes of Health Bethesda, Maryland, U.S.A Index Saccharomyces boulardii, 400 Saddle nose deformity, physical findings diagnostic features, 53 noninfectious mimics, 53 Salmonella, 352 Salmonella spp., 330 Salmonella typhi, 330 Salves antibiotics, 360 Sarcoidosis, 138 SARS See Severe acute respiratory syndrome (SARS) SARS-associated coronavirus, 474–475 SBE See Subacute bacterial endocarditis (SBE) SBP See Spontaneous bacterial peritonitis (SBP) Scalp folliculitis, in burn patients, 372 Scarlet fever, 35 SCCmec See Staphylococcal cassette chromosome mec (SCCmec) Scedosporium prolificans, 395 Scedosporium spp infection, in SOT recipients, 395 Schistosomiasis, 331, 402 SCID See Severe combined immunodeficiency syndrome (SCID) Scrotal, physical findings diagnostic features, 61 noninfectious mimics, 61 PE findings, 61 Scrotal purpura, physical findings diagnostic features, 60 noninfectious mimics, 60 SDD See Selective decontamination of digestive tract (SDD) Secondary syphilis, 32, 71 Selective decontamination of digestive tract (SDD), 185 Semi-quantitative (SQ) catheter tip cultures, 208 Sensorineural hearing loss, physical findings diagnostic features, 52 noninfectious mimics, 52 Sepsis, 525 burn wound infections and, 368–369 clinical conditions associated with, 129 clinical mimics of, 130 clinical signs of, 128, 129 defined, 26 diagnostic approach, 128 empiric therapy of, 130, 131 laboratory abnormalities in, 130 mimics, 131 syndrome, mechanism of in asplenic patients, 350–351 Sepsis-related organ failure assessment, 261 Septic emboli, 96 Septicemic plague, 477 Septic shock, 26–27 diagnosis of, 26 mortality rate, 26–27 Septic syndrome, 528 Septic thrombophlebitis, CVC infections and, 208, 209 S aureus ABE, 210–214 577 Serious systemic infections, 500, 501 anti-MRSA antibiotics for, 506–507 Serotonin syndrome, 549 Serratia marcescens, 302 Serum CRP, 147 ferritin levels, 147 PCT, 147 Serum protein electrophoresis (SPEP), 138 Serum sickness, 137 Serum transaminases, 10 Severe acute respiratory syndrome (SARS), 328, 473, 474–475 Severe combined immunodeficiency syndrome (SCID), 378 Shigella spp., 330 Shigellosis, 330 Shock, severe CAP with diagnostic approach, 166 functional/anatomic hyposplenia and, 166 Silver nitrate, 362 Silver sulfadiazine, 361 Single fever spikes, 6–8 Single nucleotide polymorphisms (SNPs), 369 Sinusitis, in burn patients, 372 Skin and soft tissue infections bites, 301–302 carbuncles, 297 cellulitis, 298–299 diagnosis of, 299 treatment, 300 chancriform lesions, anthrax, 300–301 classification of, 296–297 community-acquired methicillin-resistant S aureus (CA-MRSA), 315–316 diabetic foot infection, 308–309 ecthyma gangrenosum, 310 erysipelas, 297–298 treatment, 298 erysipeloid, 300 furuncles, 297 in immunocompromised host, 310 impetigo, 297 in injection drug users, 309 microbial flora, 295–296 necrotizing infections cellulitis, 302 Fournier’s gangrene, 305 gas gangrene, 305–307 necrotizing fasciitis (NF), 302–305 nonclostridial myonecrosis, 307–308 pyomyositis, 308 surgical site infections (SSIs), 310–311 systemic syndromes purpura fulminans, 315 staphylococcal scalded skin syndrome (SSSS), 311–312 toxic shock syndrome (TSS), 312–314 SLE See Systemic lupus erythematosis (SLE); Systemic lupus erythematosus (SLE) Smallpox, 37–38, 476–477 578 Sodium hypochlorite, 362, 368 Solid-organ transplant (SOT), 387 clinical syndromes bacteria, 392–394 bloodstream infections, catheter-related infections, and infective endocarditis, 403–404 fever, noninfectious causes of, 405 fever of unknown origin, 404–405 fungal, 394–395 gastrointestinal infections, 398–400 neurological focality, 400–402 pneumonia, 391–392 postsurgical infections, 397–398 urinary tract infections, 398 viral, 395–397 diagnostic approach, 405–406 febrile processes of SOT recipients in ICU, 407–408 management of, 406–407 prevention, 408 recipients, most common infections in, 388 type of and time after, influence of, 387 anamnesis and physical examination, 390–391 appearance of infection and, time of, 389–390 underlying disease and, 388–389 SOT See Solid-organ transplant (SOT) SPEP See Serum protein electrophoresis (SPEP) Spirochetal infections, 157 Spirochetes, 158 Spleen, 350 Splenectomy, 352 Splenic abscess clinical and radiologic diagnosis of, 81–82 mimics of, 82 Splenomegaly, physical findings diagnostic features, 59 noninfectious mimics, 59 Spondyloarthropathy, 377 Spontaneous bacterial empyema, 346–347 Spontaneous bacterial peritonitis (SBP), 265–267 diagnosis of, 343 pathogenesis, 342–343 prophylaxis, 344 treatment of, 343–344 SPS See Sulfopolyanetholsulfonate (SPS) SSI See Surgical site infections (SSI) SSSS See Staphylococcal scalded skin syndrome (SSSS) St Louis encephalitis virus, 33 Staghorn calculus, in pelvis CT scan of abdomen, 77 Standard precautions, 466 for hospitalized patient, 21 in nosocomial infections, 433 Staphylococcus aureus, 549 Staphylococcal pneumonia, 94 Staphylococcal bacteremias antimicrobial therapy for, 506 Staphylococcal cassette chromosome mec (SCCmec), 103 Index Staphylococcal scalded skin syndrome (SSSS), 34–35, 311–312 diagnosis of, 35 generalized form of, 35 mortality rate in children, 35 Staphylococcal TSS, 33–34 clinical presentation of, 33 diagnosis of, 34 with toxin-producing bacteria, 33 Staphylococcus aureus, 76, 94, 135, 271, 277, 342, 392, 403 See also Methicillin-resistant S aureus (MRSA); Methicillin susceptible S aureus (MSSA) bacteremia, 38 burn wound infection, 362, 363 CAP and, 168, 170 in IE, 220–221, 222, 234, 239 antibiotic therapy of, 242–245 MSSA/MRSA ABE, 210–214 pneumonia due to, 181 skin and soft tissue infections and, 295, 296, 311 cellulitis, 298 impetigo, 297 necrotizing fasciitis (NF), 302 pyomyositis, 308 Staphylococcus epidermidis (CONS), 208 in IE, 221 Staphylococcus lugdunensis in IE, 221 Staphylococcus sciuri, 103 Stenotrophomonas maltophilia, 180 Steroids, 150 Stevens–Johnson syndrome, 31, 74, 547 Still’s disease, 378 Stool, 116 culture and CDI diagnosis, 278 Coagulase negative staphylococci (S epider midis) Straphyococcal bacteremias, 503 Streptococcal gangrene, 302 Streptococcal pyrogenic exotoxin A/B/C (Spe-A/B/C), 313 Streptococcal toxic shock syndrome (STSS), 304 Streptococcal TSS, 34 Streptococcus anginosus, 218, 220 Streptococcus bovis in IE, 218, 220 Streptococcus constellatus, 220 Streptococcus faecalis in IE, 222 Streptococcus gallolyticus, 498 Streptococcus intermedius, 218, 220 Streptococcus milleri, 218 Streptococcus mitis, 218 Streptococcus mutans, 218 Streptococcus pneumoniae, 164, 167, 170, 179, 326, 327, 342, 351, 378, 380, 392, 488 Streptococcus salivarius, 218 Streptococcus sanguis I/II, 218 skin and soft tissue infections and, 295–296 Streptomycin for pneumonic tularemia, 479 Index Stress ulcers, 265 Strongyloides stercoralis, 390 Strongyloidiasis, 402 STSS See Streptococcal toxic shock syndrome (STSS) Subacute bacterial endocarditis (SBE), 210, 223, 232, 233, 497 See also Infective endocarditis (IE) Subarachnoid space, 153 Subcutaneous nodules, physical findings diagnostic features, 51 noninfectious mimics, 51 Subglottic suctioning, 185 Submandibular lymphadenopathy, physical findings diagnostic features, 54 noninfectious mimics, 54 Subungual hemorrhages in adult patients, 27 Sulfonamide-induced fever in HIV-infected patients, 550 Sulfonamides, 545 Sulfopolyanetholsulfonate (SPS), 233, 234 Supra-clavicular lymphadenopathy, physical findings diagnostic features, 55 noninfectious mimics, 55 Surgical ICU (SICU) patient, intra-abdominal infections in See Intra-abdominal surgical infections Surgical site infections (SSIs), 310–311, 397 Swine influenza (H1N1), clinical diagnosis of, 171 Sydenham’s chorea, 41 Symblepharon, 74 Symptomatic rabies (stage III), 480 Syphilis primary, 71 secondary, 71 tertiary, 72 Systemic antimicrobial therapy, for burn wound infection, 367 Systemic fungal infections, 40–41 Systemic inflammatory response syndrome (SIRS), 360, 369, 487 Systemic lupus erythematosus (SLE), 1, 19, 73, 90, 128, 137, 167, 237, 382 TAA See Teichoic acid antibody (TAA) TAAb See Teichoic acid antibody (TAAb) titers Target sign, 84, 87 Tazobactam, 491, 494 TB See Mycobacterium tuberculosis (TB) TB See Tuberculosis (TB) TB infection See Tuberculosis (TB) infection T-cell activation and migration, 379–380 See also Biologic agents Tc-99m See Technitium-99m (Tc-99m) Technitium-99m (Tc-99m), 76 TEE See Transesophageal echocardiography (TEE) Teichoic acid antibody (TAA), 209 579 Teichoic acid antibody (TAAb) titers, 504 Teicoplanin, for CDI treatment, 283 Telavancin, 193, 316 Temporal arteritis/giant cell arteritis (TA/GCA), 73 TEN See Toxic epidermal necrolysis (TEN) TEN, cutaneous drug reaction, 31–32 defined, 31 diagnosis of, 32 Tender hepatomegaly, physical findings diagnostic features, 59 noninfectious mimics, 59 Tender violaceous acral papules, physical findings diagnostic features, 51 noninfectious mimics, 51 Tertiary syphilis, 72 Tetracyclines, 537 for RMSF, 25 Tetrahydrobiopterin (BH4), 481 Thorax infections and mimic pneumonia See Pneumonia Thrombocytopenia, 130, 388, 424, 546 Thrombocytosis, 424 Thrombotic thrombocytopenic purpura (TTP), 384 Thyroid, physical findings diagnostic features, 56 noninfectious mimics, 56 Tigecycline, 193, 245, 494 T-lymphocyte function (CMI), CAP and, 169 TMP-SMX See Trimethoprim/sulfamethoxazole (TMP-SMX) TNF See Tumor necrosis factor (TNF) TNF-a See Tumor necrosis factor alpha (TNF-a) Tobramycin, 527, 545 Tocilizumab, 378 Tolerant strains, 508 Tongue ulcer, physical findings diagnostic features, 53 noninfectious mimics, 53 Tonsillar, physical findings diagnostic features, 53 noninfectious mimics, 53 Total parental nutrition (TPN), 208, 263 Toxic epidermal necrolysis (TEN), 311 Toxic metabolic encephalopathy, 153, 157 Toxic shock syndrome toxin (TSST-1), 311 Toxic shock syndrome (TSS), 19, 67, 312–314 staphylococcal, 33–34 streptococcal, 34 a-toxin 305, 307 Toxoplasmosis, 70, 402 clinical and radiologic diagnosis of, 88 mimics of, 88–89 TPN See Total parental nutrition (TPN) Tracheal deviation, physical findings diagnostic features, 56 enlargement and tenderness, 56 mimics, 56 Transesophageal echocardiography (TEE), 209, 235, 240, 504 Transient bacteremia, 7–8 Transthoracic echocardiography (TTE), 209, 235, 504 Index 580 Treponema pallidum, 32, 157 Trepopnea, physical findings diagnostic features, 51 noninfectious mimics, 51 Trimethoprim-sulfamethoxazole (TMP-SMX), 136, 537, 546 Tropical infections, 322 acute abdomen, 329–330 coma and meningoencephalitis, 328–329 dysentery and severe gastrointestinal fluid losses, 330 fever with eosinophilia, 331 fulminant hepatitis, 330–331 malaria, 324–325 artemesinins, 325–326 quinidine gluconate, 325 severe, treatment of, 333–334 ARDS, 326–328 toxic appearance and fever, 332, 335 Trypticase soy broth, 233 TSS See Toxic shock syndrome (TSS) TSST-1 See Toxic shock syndrome toxin (TSST-1) TTE See Transthoracic echocardiography (TTE) TTP See Thrombotic thrombocytopenic purpura (TTP) Tuberculoma, 87 Tuberculosis (TB), 155–157 CNS cavitary pneumonia and, 97 clinical and radiologic diagnosis of, 87 mimic of, 88–89 cutis acuta generalisata, 423 granuloma, 87 infection anti-TNF therapy and, 380 miliary See Miliary tuberculosis Tularemia (oculoglandular), 68, 478–479 Tumor, 79 brain, 88–89 damage, 155 emboli, 299 hepatic, 81 pineal, 90 Tumor necrosis factor alpha (TNF-a), 369, 422 Tumor necrosis factor (TNF), 350–351 T1-weighted imaging of brain, 86 HCC and, 81 T2-weighted imaging, 79, 81 of brain, 86 Typhoidal tularemia, 478 Typhoid fever, 330 UC See Ulcerative colitis (UC) UIP See Usual interstitial pneumonia (UIP) Ulcerative colitis (UC), 85 Ulceroglandular See Glandular tularemia Urinary tract infections (UTI), 288, 344, 514 See also Urosepsis in SOT recipients, 398 Urosepsis, 488 clinical presentation, 289 community-acquired, 288 defined, 288 differential diagnosis of, 289–292 empiric antimicrobial therapy, 292–293 nosocomial, 288–289 Usual interstitial pneumonia (UIP), 99 UTI See Urinary tract infections (UTI) Uvula, physical findings diagnostic features, 54 noninfectious mimics, 54 VA See Ventriculo-atrial (VA) Vancomycin, 191–192, 400, 507, 527–528, 538, 544 for c difficile diarrhea, 280–281 dose of, 193 MSSA/MRSA ABE, 211, 213 treats most gram-positive pathogens, 493 Vancomycin-resistant enterococci (VRE), 220, 280, 308, 389, 497, 498 antimicrobial therapy, 499–501 clinical spectrum of, 499 control measures for, in ICU, 119 cost effectiveness, 118–119 epidemiology, 113–115, 499 microbiology of, 498–499 prevention and control of, in ICUs antimicrobial agents, 117–118 contact precautions, 116 culture surveillance, 116 decontamination of environment, 117 risk factors for acquisition of in adult ICUs, 113–114 sources of, 113 transmission of, in ICU, 113 type of infection caused by in adult ICUs, 112 in neonatal ICUs, 113 Vancomycin-resistant S aureus (VRSA), 308 Vancomycin susceptible enterococci (VSE), 114, 497, 498 VAP See Ventilator-associated pneumonia (VAP) Varicella zoster virus (VZV), 36, 395 Veridans streptococci, 36, 179, 241 MVP 218 Variola virus, 37 VDRL See Venereal disease research laboratory (VDRL) Venereal disease research laboratory (VDRL), 158 Ventilation/perfusion (V/Q) scan, 92 Ventilator-associated pneumonia (VAP), 488, 514–515 antimicrobial treatment adequate dosing, 193 aerosolized antibiotics, 193–195 duration of therapy, 196 empiric antibiotic therapy for, 190–191 Index [Ventilator-associated pneumonia (VAP) antimicrobial treatment] etiologic microorganism, treatment based on, 191–193 monotherapy vs combination therapy, 195 treatment failure, causes of, 196 defined, 178 diagnosis of, 187, 191 CPIS score and, 187 etiologic, 188 gram stain technique, 188–189 patient response assessment and, 190 preemptive rapid cultures, 189–190 quantitative cultures, 188, 189 surveillance, value of, 190 epidemiology, 178–179 microbiology, 180–182 multidrug-resistant (MDR)–related rates of, 180 pathogenesis of, 179–180 prevention, 182–186 risk factors, 182 Ventriculo-atrial (VA) shunts, 504 Veridans streptococci, 36, 179 in SBE, 36, 179 MVP, 218 VHF See Viral hemorrhagic fever (VHF) Vibrios, 346 Vibrio vulnificus, 19, 38–39, 299, 300, 302 diagnosis of, 39 mortality rate in, 39 skin lesions with, 39 Viral hemorrhagic fevers (VHF), 332, 335, 475–476 Viral infections burn wound infections and, 369 infections, in SOT recipients, 395–397 VISA (vancomycin intermediate susceptible S aureus), 110, 312, 507 581 V/Q scan See Ventilation/perfusion (V/Q) scan VRE See Vancomycin-resistant enterococci (VRE) VRSA See Vancomycin-resistant S aureus VRSA) VSE See Vancomycin-sensitive enterococci (VSE); Vancomycinsusceptible enterococci (VSE) VZV See Varicella zoster virus (VZV) Waterhouse–Friderichsen syndrome, 351 Wegener’s granulomatosis, 73 Weil’s syndrome See Leptospirosis (Weil’s syndrome) West Nile encephalitis (WNE), 147 West Nile virus (WNV), 32–33, 155, 160, 401 Wheezing, physical findings diagnostic features, 57 noninfectious mimics, 57 WHO See World Health Organization (WHO) WNE See West Nile encephalitis (WNE) WNV See West Nile virus (WNV) World Health Organization (WHO), 325 Xanthogranulomatous pyelonephritis (XGPN), 76 XDR TB See Extensive drug-resistant (XDR) TB X rays chest, 51, 138, 156, 187, 395, 396, 424, 427, 439, 474, 476, 515 Yellow fever (YF) Virus, 331 Yersinia enterocolitica, 330 Zoonosis, 160 Zoster See Herpes zoster (VZV) [vijay][7Â10 Tight][D:/informa_Publishing/H9240_Cunha_2400011/z_production/ z_3B2_3D_files/978-1-4200-9240-0_COLOR_INSERT_O.3d] [19/8/09/14:32:25] [1–8] Figure 4.1 Interstitial keratitis (see page 67 ) Figure 4.2 Cystoid macular edema (see page 67 ) Figure 4.3 Optic neuritis (see page 68 ) [vijay][7Â10 Tight][D:/informa_Publishing/H9240_Cunha_2400011/z_production/ z_3B2_3D_files/978-1-4200-9240-0_COLOR_INSERT_O.3d] [19/8/09/14:32:25] [1–8] Figure 4.4 Branch retinal artery occlusion (see page 69 ) Figure 4.5 Keratic precipitates (see page 69 ) Figure 4.6 CMV retinitis (see page 69 ) [vijay][7Â10 Tight][D:/informa_Publishing/H9240_Cunha_2400011/z_production/ z_3B2_3D_files/978-1-4200-9240-0_COLOR_INSERT_O.3d] [19/8/09/14:32:25] [1–8] Figure 4.7 “Frosted branch angiitis” (see page 69 ) Figure 4.8 “Headlight in the fog” (see page 70 ) Figure 4.9 Branch retinal vein occlusion (see page 70 ) [vijay][7Â10 Tight][D:/informa_Publishing/H9240_Cunha_2400011/z_production/ z_3B2_3D_files/978-1-4200-9240-0_COLOR_INSERT_O.3d] [19/8/09/14:32:25] [1–8] Figure 4.10 “Macular star” (see page 70 ) Figure 4.11 Pseudodendritic keratitis (see page 71 ) Figure 4.12 Optic atrophy (see page 72 ) [vijay][7Â10 Tight][D:/informa_Publishing/H9240_Cunha_2400011/z_production/ z_3B2_3D_files/978-1-4200-9240-0_COLOR_INSERT_O.3d] [19/8/09/14:32:25] [1–8] Figure 4.13 Keratic precipitates (see page 72 ) Figure 4.14 Band keratopathy (see page 72 ) Figure 4.15 Candle wax drippings (see page 72 ) [vijay][7Â10 Tight][D:/informa_Publishing/H9240_Cunha_2400011/z_production/ z_3B2_3D_files/978-1-4200-9240-0_COLOR_INSERT_O.3d] [19/8/09/14:32:25] [1–8] Figure 4.16 Cotton-wool spots (see page 73 ) Figure 4.17 Retinal vasculitis (see page 73 ) Figure 4.18 Hollenhorst plaque (see page 74 ) [vijay][7Â10 Tight][D:/informa_Publishing/H9240_Cunha_2400011/z_production/ z_3B2_3D_files/978-1-4200-9240-0_COLOR_INSERT_O.3d] [19/8/09/14:32:25] [1–8] Figure 4.19 Symblepharon (see page 74 ) Figure 4.20 Hemorrhagic conjunctivitis (see page 74 ) [vijay][7Â10 Tight][D:/informa_Publishing/H9240_Cunha_2400011/z_production/ z_3B2_3D_files/978-1-4200-9240-0_COLOR_INSERT_O.3d] [19/8/09/14:32:25] [1–8] Figure 4.21 Lipemia retinalis (see page 75 ) Figure 4.22 Purtscher’s-like retinopathy (see page 75 ) I’am the Bulk-Adjust me! I’am the Bulk-Adjust me! IDT_7X10_IBT_Template.indd unique features… Review of the Second Edition “Senior trainees and practitioners in critical care medicine are an appropriate audience for this work Infectious disease consultants may also benefit from the perspectives presented here The editor is an international authority on infections in the critical care unit An international group of expert authors has been recruited” about the editor… Infectious Diseases in Critical Care Medicine Infectious Diseases in Critical Care Medicine about Infectious Diseases in Critical Care Medicine, Third Edition… Third Edition Third Edition 128942-Cunha PMS 540 Infectious Disease NFECTIOUS ISEASE INFECTIOUS DISEASE AND HERAPY ERIES AND THERAPY SERIES Volume 51 Infectious Diseases in Critical Care Medicine Third Edition Printed in the United States of America Printed in the United States of America Cunha Edited by Burke A Cunha Cunha_978-1420092400.indd Cunha_978-1420092400.indd 10/5/09 4:20:07 PM 10/5/09 4:20:07 PM PMS 540C ... becoming important in critical care Infectious Diseases in Critical Care Medicine (third edition) remains the only book exclusively dedicated to infectious diseases in critical care Importantly, Infectious. .. Infectious Diseases in Critical Care Medicine (third edition) is written from the infectious disease perspective by clinicians for clinicians who deal with infectious diseases in critical care The infectious. .. noninfectious diseases remain an important component of infectious diseases in the second edition The second edition of Infectious Diseases in Critical Care Medicine emphasizes differential clinical