Contemporary issues with bacterial infection in the intensive care unit

Nosocomial infection in the critically ill results from defects in the intr insic barriers to microbial invasion. The diagnosis is complicated by an in ability to perform an adequate physical examination in a patient with sever al compounding findings, usually necessitating sophisticated technologies t o aid in the diagnosis. Pneumonia, line sepsis, urosepsis, sinusitis, endoc arditis, peritonitis, and acalculous cholecystitis are the more common infe ctions that challenge the care of the critically ill. Antibiotic therapy is adjunctive to efforts to preserve the barrier, but should be started early , should be targeted as specifically as possible to the offending organisms , and should be dosed adequately to ensure an effective concentration in th e infected tissue.