Infection and Immune System

Abstract

Infections are a major cause of mortality in intensive care unit (ICU) patients and the most common non-cardiac complications after cardiac surgery. Commonly encountered infections in the cardiothoracic ICU include pneumonia, bloodstream infections, and surgical site infections. At the beginning of this chapter, general measures of infection control and prevention are introduced. Those can help reduce infections and are best implemented in a bundled care fashion. Specifically for ICU patients, care bundles aimed at ventilator-associated pneumonia and central line-associated bloodstream infection have been successfully implemented, studied, and revised. In the next section, antibiotic treatment principles are described. Treatment with antibiotic drugs is an important part of therapy for infectious complications and is under continuous revision given the changing and diverse spectrum of microorganisms and the emergence of multidrug-resistance. In the central part of the chapter, specific infections are discussed in detail with regards to etiology, incidence, diagnosis, and therapy. Finally, the concept of systemic inflammatory response is described which is a common clinical problem after cardiac surgery, particularly with the use of cardiopulmonary bypass. Several immunologic mechanisms have been found to be associated with this and the clinical picture can be confused with sepsis.