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Critical Care

, 18:572

Year in review 2013


Infectious complications, particularly in the respiratory tract of critically ill patients, are related to increased mortality. Severe infection is part of a multiple system illness and female patients with severe sepsis have a worse prognosis compared to males. Kallistatin is a protective hormokine released during monocyte activation and low levels in the setting of septic shock can predict adverse outcomes. Presepsin is another biomarker that was recently evaluated and is elevated in patients with severe sepsis patients at risk of dying. The Centers for Disease Control and Prevention has introduced new definitions for identifying patients at risk of ventilator-associated complications VACs, but several other conditions, such as pulmonary edema and acute respiratory distress syndrome, may cause VACs, and not all patients with VACs may have ventilator-associated pneumonia. New studies have suggested strategies to identify patients at risk for resistant pathogen infection and therapies that optimize efficacy, without the overuse of broad-spectrum therapy in patients with healthcare-associated pneumonia. Innovative strategies using optimized dosing of antimicrobials, maximizing the pharmacokinetic and pharmacodynamic properties of drugs in critically ill patients, and newer routes of drug delivery are being explored to combat drug-resistant pathogens. We summarize the major clinical studies on respiratory infections in critically ill patients published in 2013.

AbbreviationsARDSAcute respiratory distress syndrome

ATSAmerican Thoracic Society

AUCArea under the curve

BALBronchoalveolar lavage

CAPCommunity-acquired pneumonia

CDCCenters for Disease Control and Prevention

CHFCongestive heart failure

CIConfidence interval

CpeakPeak concentration

ETAEndotracheal aspirate

GRVGastric residual volume

HCAPHealthcare-associated pneumonia

H-IVIGHyperimmune IV immunoglobulin

IDSAInfectious Disease Society of America

IVACInfection-related ventilator-associated complication

LOSLength of stay

MDRMulti-drug resistant

MICMinimum inhibitory concentration

MRSAMethicillin-resistant Staphylococcus aureus MSSA, Methicillin-sensitive Staphylococcus aureus

MVMechanical ventilation

OFASequential Organ Failure Assessment

OROdds ratio

PAPseudomonas aeruginosa

PAOPredictors of adverse outcome

PCRPolymerase chain reaction




PSIPneumonia Severity Index

PVLPanton-Valentine leucocidin

RTReverse transcriptase

VACVentilator-associated complication

VAPVentilator-associated pneumonia

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0572-3 contains supplementary material, which is available to authorized users.

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Author: Girish B Nair - Michael S Niederman


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