Limiting the Attributable Mortality of Healthcare-Associated Infections and Multidrug Resistance in Critically Ill Patients
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Session presented on Friday, July 24, 2015: Severe healthcare-associated infections are associated with a poor prognosis for patients cared for in intensive care units. This is partly because most of these patients suffer from high disease severity and acute illness before the onset of infection. Nevertheless, the mortality attributed directly to severe infection or sepsis can also be devastating. Within the context of healthcare-associated infections, antimicrobial multidrug resistance boosts the deleterious effect of severe infections. Due to multidrug resistance the empirically initiated ('blind') antimicrobial therapy more often appears to be inappropriate by which the time till effective therapy is prolonged. The harmful effect of healthcare-associated infection and multidrug resistance can be limited by taking into account of a number of key points. Although caring for the critically ill patient is a multidisciplinary task, in all of these key points nurses play an important role. First, general infection prevention measures, prevention of cross-transmission and a policy of restricted antimicrobial use are all important because of their positive influence on the rates of infection and antimicrobial multidrug resistance. Second, as the prevalence of infection and multidrug resistance in particular is reduced, there will be an increased likelihood for successful empirical coverage of the causative microorganism. Third, once infection or sepsis occurs, benefits are to be expected from early recognition of the septic episode and prompt initiation of empirical antimicrobial therapy. Fourth, the choice of empirical therapy should be based on the local bacterial ecology and patteRNof resistance, the presence of risk factors for multidrug resistance, and the colonisation status of the patient. Fifth, attention should also be given to adequate dosing of antimicrobial agents. In this regard, respecting dosing intervals and perfusion duration is crucial. Sixth, if possible, elimination of sources of the infection is recommended, e.g., contaminated devices or intra-abdominal collections or leakages. In the latter case, timely surgical intervention is essential. Finally, haemodynamic stabilisation and optimisation of tissue oxygenation can be life-saving.