Infectious Diseases in Critical Care Medicine Cunha_978-1420092400_TP.indd 1 10/5/09 4:21:18 PM INFECTIOUS DISEASE AND THERAPY Series Editor Burke A. Cunha Winthrop-University Hospital Mineola,NewYork and StateUniversity ofNewYorkSchoolof Medicine StonyBrook,NewYork 1. ParasiticInfectionsinthe CompromisedHost,editedby Peter D.WalterandRobert M. Genta 2. Nucleic Acid and Monoclonal Antibody Probes: Applications in Diagnostic Method- ology, edited by Bala Swaminathan and Gyan Prakash 3. Opportunistic Infections in Patients with the Acquired Immunodeficiency Syndrome, edited by Gifford Leoung and John Mills 4. Acyclovir Therapy for Herpesvirus Infections, edited by David A. Baker 5. The New Generation of Quinolones, edited by Clifford Siporin, Carl L. Heifetz, and John M. Domagala 6. Methicillin-Resistant Staphylococcus aureus: Clinical Management and Laboratory Aspects, edited by Mary T. Cafferkey 7. Hepatitis B Vaccines in Clinical Practice, edited by Ronald W. Ellis 8. The New Macrolides, Azalides, and Streptogramins: Pharmacology and Clinical Applications, edited by Harold C. Neu, Lowell S. Young, and Stephen H. Zinner 9. Antimicrobial Therapy in the Elderly Patient, edited by Thomas T. Yoshikawa and Dean C. Norman 10. ViralInfectionsoftheGastrointestinalTract:SecondEdition,RevisedandExpanded, edited by Albert Z. Kapikian 11. Development and Clinical Uses of Haemophilus b Conjugate Vaccines, edited by Ronald W. Ellis and Dan M. Cranoff 12. PseudomonasaeruginosaInfectionsandTreatment,editedbyAldonaL.Battchand Raymond P. Smith 13. Herpesvirus Infections, edited by Ronald Glaser and James F. Jones 14. Chronic Fatigue Syndrome, edited by Stephen E. Straus 15. Immunotherapy of Infections, edited by K. Noel Masihi 16. Diagnosis and Management of Bone Infections, edited by Luis E. Jauregui 17. DrugTransportinAntimicrobialandAnticancerChemotherapy,editedbyNafsikaH. Georgopapadakou 18. NewMacrolides,Azalides,andStreptograminsinClinicalPractice,editedbyHarold C. Neu, Lowell S. Young, Stephen H. Zinner, and Jacques F. Acar 19. Novel Therapeutic Strategies in the Treatment of Sepsis, edited by David C. Morrison and John L. Ryan 20. Catheter-Related Infections, edited by Harald Seifert, Bernd Jansen, and Barry M. Farr 21. ExpandingIndicationsfortheNewMacrolides,Azalides,andStreptogramins,edited try Stephen H. Zinner, Lowell S. Young, Jacques F. Acar, and Harold C. Neu 22. Infectious Diseases in Critical Care Medicine, edited by Burke A. Cunha 23. NewConsiderationsforMacrolides,Azalides,Streptogramins,andKetolides,edited by Stephen H. Zinner, Lowell S. Young, Jacques F. Acar, and Carmen Ortiz-Neu 24. Tickborne Infectious Diseases: Diagnosis and Management, edited by Burke A. Cunha 25. Protease Inhibitors in AIDS Therapy, edited by Richard C. Ogden and Charles W. Flexner 26. Laboratory Diagnosis of Bacterial Infections, edited by Nevio Cimolai 27. Chemokine Receptors and AIDS, edited by Thomas R. O’Brien 28. Antimicrobial Pharmacodynamics in Theory and Clinical Practice, edited by Charles H. Nightingale, Takeo Murakawa, and Paul G. Ambrose 29. Pediatric Anaerobic Infections: Diagnosis and Management, Third Edition, Revised and Expanded, Itzhak Brook 30. ViralInfectionsandTreatment,editedbyHelgaRuebsamen-Waigmann,KarlDeres, Guy Hewlett, and Reinhotd Welker 31. Community-Aquired Respiratory Infections, edited by Charles H. Nightingale, Paul G. Ambrose, and Thomas M. File 32. Catheter-RelatedInfections:SecondEdition,editedbyHaraldSeifert,BerndJansen, and Barry Farr 33. AntibioticOptimization:ConceptsandStrategiesinClinicalPractice(PBK),editedby Robert C. Owens, Jr., Charles H. Nightingale, and Paul G. Ambrose 34. Fungal Infections in the Immunocompromised Patient, edited by John R. Wingard and Elias J. Anaissie 35. Sinusitis: From Microbiology To Management, edited by Itzhak Brook 36. Herpes Simplex Viruses, edited by Marie Studahl, Paola Cinque and Toms Bergstro¨m 37. Antiviral Agents, Vaccines, and Immunotherapies, Stephen K. Tyring 38. Epstein-Barr Virus, edited by Alex Tselis and Hal B. Jenson 39. Infection Management for Geriatrics in Long-Term Care Facilities, Second Edition, edited by Thomas T. Yoshikawa and Joseph G. Ouslander 40. Infectious Diseases in Critical Care Medicine, Second Edition, edited by Burke A. Cunha 41. Infective Endocarditis: Management in the Era of Intravascular Devices, edited by John L. Brusch 42. Fever of Unknown Origin, edited by Burke A. Cunha 43. Rickettsial Diseases, edited by Didier Raoult and Philippe Parola 44. Antimicrobial Pharmacodynamics in Theory and Clinical Practice, Second Edition, edited by Charles H. Nightingale, Paul G. Ambrose, George L. Drusano, and Takeo Murakawa 45. Clinical Handbook of Pediatric Infectious Disease, Third Edition, Russell W. Steele 46. Anaerobic Infections: Diagnosis and Management, Itzhak Brook 47. Diagnosis of Fungal Infections, edited by Johan A. Maertens and Kieren A. Marr 48. AntimicrobialResistance:ProblemPathogensandClinicalCountermeasures,edited by Robert C. Owens, Jr. and Ebbing Lautenbach 49. Lyme Borreliosis in Europe and North America, edited by, Sunil Sood 50. Laboratory Diagnosis of Viral Infections, Fourth Edition, edited by Keith R. Jerome 51. Infectious Diseases in Critical Care Medicine, Third Edition, edited by Burke A. Cunha Infectious Diseases in Critical Care Medicine Third Edition Edited by Burke A. Cunha Winthrop-University Hospital Mineola, New York, USA State University of New York School of Medicine Stony Brook, New York, USA Cunha_978-1420092400_TP.indd 2 10/5/09 4:21:18 PM InformaHealthcareUSA,Inc. 52VanderbiltAvenue NewYork,NY10017 #2010byInformaHealthcareUSA,Inc. InformaHealthcareisanInformabusiness NoclaimtooriginalU.S.Governmentworks PrintedintheUnitedStatesofAmericaonacid-freepaper 10 9 8 7 6 5 4 3 2 1 InternationalStandardBookNumber-10:1-4200-9240-5(hardcover:alk.paper) InternationalStandardBookNumber-13:978-1-4200-9240-0(hardcover:alk.paper) Thisbookcontainsinformationobtainedfrom authenticandhighlyregarded sources.Reprinted materialis quotedwith permission,andsourcesareindicated.Awidevarietyofreferencesarelisted.Reasonableeffortshavebeenmadetopublish reliabledataandinformation,buttheauthorandthepublishercannotassumeresponsibilityforthevalidityofallmaterials orfortheconsequenceoftheiruse. Nopartofthisbookmaybereprinted,reproduced,transmitted,orutilizedinanyformbyanyelectronic,mechanical,or othermeans,nowknownorhereafterinvented,includingphotocopying,microfilming,andrecording,orinanyinformation storageorretrievalsystem,withoutwrittenpermissionfromthepublishers. For permissiontophotocopyor usematerialelectronicallyfromthiswork,please accesswww.copyright.com(http:// www.copyright.com/)orcontacttheCopyrightClearanceCenter,Inc.(CCC)222RosewoodDrive,Danvers,MA01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizationsthathavebeengrantedaphotocopylicensebytheCCC,aseparatesystemofpaymenthasbeenarranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identificationandexplanationwithoutintenttoinfringe. LibraryofCongressCataloging-in-PublicationData Infectiousdiseasesincriticalcaremedicine/editedbyBurkeA. Cunha.–3rded. p.;cm.— (Infectiousdiseaseandtherapy;51) Includesbibliographicalreferencesandindex. ISBN-13:978-1-4200-9240-0(hardcover:alk.paper) ISBN-10:1-4200-9240-5(hardcover:alk.paper) 1. Nosocomial infections.2. Criticalcaremedicine.3. Intensivecareunits. I.Cunha,BurkeA.II.Series:Infectiousdiseaseandtherapy;51. [DNLM:1. CommunicableDiseases—diagnosis.2. Communicable Diseases—therapy.3. CriticalCare.4. Diagnosis,Differential.5. IntensiveCareUnits. W1IN406HMNv.512009/WC100I41652009] RC112.I45952009 616.900475—dc22 2009022304 ForCorporateSalesandReprintPermissionscall212-520-2700orwriteto:SalesDepartment,52VanderbiltAvenue, 7thfloor,NewYork,NY10017. VisittheInformaWebsiteat www.informa.com andtheInformaHealthcareWebsiteat www.informahealthcare.com for Marie Peerless wife and mother, Provider of domestic peace and tranquility, Paragon of truth and beauty, Paradigm of earthly perfection . . . With gratitude for her love and constant support. Foreword In the United States during the 1950s, the development of mechanical ventilation led to the organization of special units in hospitals, where health care personnel with specific expertise could efficiently focus on patients with highly technical or complex needs. Over the ensuing years the sickest patients as well as those needing mechanical ventilation were grouped into special care units. In 1958, Baltimore City Hospital developed the first multidisciplinary intensive care unit. The concept of physician coverage 24 hours a day, seven days a week became a logical approach to providing optimal care to the sickest, most complex patients. Now,50years afterthe firstmultidisciplinary intensive care unitwasopened,there are now 5000 to 6000 intensive care units in the United States: Over 4000 hospitals offer one or more critical care units, and there are 87,000 intensive care unit beds. Critical care represents 13.3% of hospital costs, totaling over $55 billion per year. Healthcareprovidersarewellawareoftherolethatinfectionsplayintheintensivecare unit. A substantial number of patients are admitted to the intensive care unit because of an infectionsuchaspneumonia,meningitis,orsepsis.Asubstantialnumberofpatientsadmitted to intensive care units for noninfectious disorders develop infections during their stay. Thus, intensivists need expertise in the diagnosis, treatment, and prevention of infectious diseases. Management of infections is pivotal to successful outcomes. In this third edition of Infectious Diseases in Critical Care Medicine, Burke Cunha has organized31chaptersintoanexceedinglypracticalandusefuloverview.Providersoftenfind itsurprisinglydifficulttodistinguishinfectiousandnoninfectioussyndromes,especiallywhen patients have life-threatening processes that evoke similar systemic inflammatory responses. PartIandPartIIprovidemanyclinicalpearlsthathelpwithdiagnosisandwithdevelopinga strategy for initial patient management. Specific chapters focus on special intensive care unit problems, such as central venous catheter infections, nosocomial pneumonias, endocarditis, and Clostridium difficile infection. Particularly useful are chapters on special populations that many clinicians rarely encounter: tropical diseases, cirrhosis, burns, transplants, or tubercu- losis. Chapters on therapy also provide practical advice focused on critically ill patients, in whomchoiceofagent,toxicities,druginteractions,andpharmacokineticsmaybesubstantially different from patients who are less seriously ill. Critical care medicine is becoming more and more technology based. Genomics and proteomics can predict susceptibility to various diseases and drug metabolic problems. Patients can be assessed by ultrasonography to supplement physical examination. Diagnostic biopsiescanbeperformedonvirtuallyanyorgan.Invasivearterialandvenousmonitoringas well as monitoring of central nervous system and cardiac activity is commonplace. Despite these advances in technology, knowledge of differential diagnosis, natural history, and therapeutic options is still essential. To understand these processes, Burke Cunha has assembled an impressive team of experienced clinicians to provide insight into the infectious challengesofcriticalcaremedicine.Thiseditioncontinuestoproviderelevant,currentinformation thatwillenhanceclinicalpracticewiththisgrowingsegmentofhospitalizedpatients. Henry Masur Department of Critical Care Medicine Clinical Center National Institutes of Health Bethesda, Maryland, U.S.A.