Infectious Diseases I

Learning Objectives

Develop risk factor–based empiric antibiotic regi-

mens for patients with suspected ventilator-associated

pneumonia.

plans for patients with central line-associated blood-

stream infections and catheter-related urinary tract

infections.

Differentiate between location of intra-abdominal

infections and respective empiric antimicrobial

therapy, including the role of antibiotics in patients

with acute pancreatitis.

Develop a definitive management strategy for

critically ill patients with severe Clostridioides

difficile infection.

Describe the role of pharmacotherapy and recom-

mend appropriate therapy for patients with severe

postoperative wound infection or severe cutaneous

infections.

Identify a disease-specific and supportive care man-

agement plan for critically ill patients with severe

influenza and novel severe acute respiratory syn-

drome coronavirus 2.

Acute respiratory distress syndrome

BAL

Bronchoalveolar lavage

CAUTI

Catheter-associated urinary tract

infection

CDI

Clostridioides difficile infection

CLABSI

Central line–associated bloodstream

infection

COVID-19

Coronavirus disease 2019

CVC

Central venous catheter

ECMO

Extracorporeal membrane

oxygenation

ED

Emergency department

ICU

Intensive care unit

IDSA

Infectious Diseases Society of

America

IVIG

Intravenous immunoglobulin

MDRO

Multidrug-resistant organism

MICU

Medical intensive care unit

MRSA

Methicillin-resistant Staphylococcus

aureus

MRSE

Methicillin-resistant Staphylococcus

epidermidis

MSSA

Methicillin-sensitive Staphylococcus

aureus

MV

Mechanical ventilation

NHSN

National Healthcare Safety Network

syndrome coronavirus 2

RT-PCR

Reverse transcription polymerase

chain reaction

SICU

Surgical intensive care unit

SIRS

Systemic inflammatory response

syndrome

UTI

Urinary tract infection

VAP

Ventilator-associated pneumonia

Self-Assessment Questions

Answers and explanations to these questions may be

found at the end of this chapter.

Questions 1 and 2 pertain to the following case.

K.P., a 38-year-old otherwise healthy woman, was

involved in a motor vehicle collision, sustaining a trau-

matic brain injury and severe chest injuries requiring

endotracheal intubation and mechanical ventilation

(MV). After being in the trauma intensive care unit

(ICU) for 96 hours, a new infiltrate is noted on her chest

radiograph, as well as a temperature of 101.9°F (38.8°C),

a white blood cell count (WBC) of 15 x 103 cells/mm3,

and macroscopically purulent sputum. K.P. is hemo-

dynamically stable. Accordingly, your team decides to

obtain a bronchoscopic bronchoalveolar lavage (BAL) of

the affected lung field to assess for ventilator-associated

pneumonia (VAP), where your local ICU MRSA preva-

lence is less than 10%.

Which is the most likely causative pathogen of

K.P.’s suspected VAP?

(MRSA)