{"id":202,"date":"2008-12-19T13:23:20","date_gmt":"2008-12-19T18:23:20","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=202"},"modified":"2026-01-16T08:29:03","modified_gmt":"2026-01-16T13:29:03","slug":"infectious-disease-in-the-icu-help-please-part-i","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/infectious-disease-in-the-icu-help-please-part-i\/2008\/12\/19\/","title":{"rendered":"Infectious Disease in the ICU: Help Please? Part I"},"content":{"rendered":"

\"\"<\/a><\/p>\n

I am currently attending on the inpatient service, which means I spend a good chunk of my day seeing new\u00a0ID consults and rounding on follow-ups.\u00a0 As I’m sure is true in most hospitals, many of these\u00a0consults are from the intensive care units (ICUs).<\/p>\n

After 18 years\u00a0in this ID business, I confess I still\u00a0find myself quite challenged by ICU Infectious Diseases.\u00a0 It’s not<\/em> due to the complexity of the cases, in fact just the opposite — paradoxically, there’s a sameness to the cases that is worlds away from the wonderful variety of ID\/HIV elsewhere:\u00a0 the\u00a0outpatient with fever of unknown origin, or the inpatients with\u00a0endocarditis, meningitis, orthopedic infection, HIV-related complication, or tropical fever (the stuff that makes up much of the rest of the consult volume).\u00a0 One intensivist says that once\u00a0patients\u00a0get past the first few days after admission,\u00a0most of the medical issues they face are similar.<\/p>\n

From the ID perspective, this means “rounding up the usual suspects<\/a>,” including searching for line infections, UTIs, C diff, sinusitis, pancreatitis, surgical site infections, acalculous cholecycstitis, drug fever, infected pressure ulcers and — especially — nosocomial pneumonia.<\/p>\n

There’s a sameness to these investigations that makes individualizing care difficult, and often forces us to focus on the (abundant) microbiologic data as distinguishing characterisitics.\u00a0 Just how resistant are the bacteria isolated from this patient’s respiratory sample?\u00a0 How many different possible pathogens can be cultured from a surgical drain?\u00a0 What is the significance of candida isolated from several non-sterile sites?\u00a0 How about those few colonies of coagulase negative staph on a removed line tip?<\/p>\n

So where to go for help?\u00a0 For a comprehensive “how to” for this patient population, check out the recent IDSA\/American College of Critical Care\u00a0Guidelines<\/a>.\u00a0 It’s an impressive document.<\/p>\n

And give yourself plenty of time — it’s 20 pages long, and has over 200 references.<\/p>\n

(In Part II, the issue of empiric antibiotics in the ICU.)<\/p>\n","protected":false},"excerpt":{"rendered":"

I am currently attending on the inpatient service, which means I spend a good chunk of my day seeing new\u00a0ID consults and rounding on follow-ups.\u00a0 As I’m sure is true in most hospitals, many of these\u00a0consults are from the intensive care units (ICUs). After 18 years\u00a0in this ID business, I confess I still\u00a0find myself quite […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[955],"class_list":["post-202","post","type-post","status-publish","format-standard","hentry","category-health-care","tag-unanswerable-questions-in-infectious-diseases"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/202","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=202"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/202\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=202"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=202"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=202"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}