INFECTION IN THE IMMOBILE HOST - A PRACTICAL REVIEW FOR THE INTENSIVE-CARE PHYSICIAN

Immobility in the critically ill patient is a significant risk factor for infection, independent of the patient's underlying critical illnes s. Specific causes of infection related to immobility in the intensive care setting are explored. The pathogenesis, treatment, complications , and prevention of pressure ulcers, pneumonia, and urinary tract infe ctions in the immobile patient are emphasized. Featured topics include the differentiation of colonization versus infection in pressure ulce rs and the urinary tract, the significance and optimal treatment of po sitive fungal cultures, as well as a rational clinical approach to the immobile patient with a fever and no obvious source of infection. The clinical relevance of anaerobic infections in this population is emph asized because it influences empiric antibiotic therapy and differenti al diagnosis.