Infectious Diseases in Critical Care Medicine
Cunha_978-1420092400_TP.indd 1 10/5/09 4:21:18 PM INFECTIOUS DISEASE AND THERAPY
Burke A. Cunha
StateUniversity ofNewYorkSchoolof Medicine
1. ParasiticInfectionsinthe CompromisedHost,editedby Peter D.WalterandRobert
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
edited by Albert Z. Kapikian
11. Development and Clinical Uses of Haemophilus b Conjugate Vaccines, edited by
Ronald W. Ellis and Dan M. Cranoff
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
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.
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.
25. Protease Inhibitors in AIDS Therapy, edited by Richard C. Ogden and Charles W.
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
Guy Hewlett, and Reinhotd Welker
31. Community-Aquired Respiratory Infections, edited by Charles H. Nightingale, Paul
G. Ambrose, and Thomas M. File
and Barry Farr
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
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.
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
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
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.
Burke A. Cunha
Mineola, New York, USA
State University of New York School of Medicine
Stony Brook, New York, USA
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ISBN-10:1-4200-9240-5(hardcover:alk.paper) 1. Nosocomial
infections.2. Criticalcaremedicine.3. Intensivecareunits.
[DNLM:1. CommunicableDiseases—diagnosis.2. Communicable
Diseases—therapy.3. CriticalCare.4. Diagnosis,Differential.5.
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 afterthefirstmultidisciplinary intensive careunitwasopened,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.
unit. A substantial number of patients are admitted to the intensive care unit because of an
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
patients have life-threatening processes that evoke similar systemic inflammatory responses.
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
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 assessedby ultrasonography to supplement physical examination. Diagnostic
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
Department of Critical Care Medicine
National Institutes of Health
Bethesda, Maryland, U.S.A.
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