Management of bacterial complications in critically ill patients: Surgicalwound and catheter-related infections

The occurrence of surgical wound infections and/or bacteremia associated wi th central venous catheter use are of growing concern to all physicians who treat critically ill patients. The physician must be aware that some patie nts have an even greater risk for infection, such as those with multiple ri sk factors, those who are on central lines, or those patients who undergo m ultiple invasvive diagnostic or therapeutic procedures. The emergence of re sistant pathogens, particularly Gram-positive pathogens, is an important fa ctor in the morbidity and mortality of hospitalized patients. In the face o f this growing resistance among target organisms, the selection of the corr ect antimicrobial and nonpharmacologic interventions, based on correct iden tification and susceptibility test data, has become increasingly challengin g. Methicillin-resistant Staphylococcus aureus and, more recently, glycopep tide-resistant enterococci and staphylococci represent a significant danger to the patient. As a consequence, earlier and more precise identification of the pathogens most frequently associated with infection is essential. Th e role of exacting surgical technique, infection control measures, and the appropriate use of prophylactic and therapeutic antibiotics cannot be overe stimated in helping to reduce potential morbidity and mortality associated with severe surgical infection. The development of new antibiotics may help treat the difficult cases attributable to resistant Gram-positive bacteria . (C) 1999 Elsevier Science Inc.