الفهرس 
Source of Infection in ICUOnly 14 pages are availabe for public view
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Abstract
Patients admitted to intensive-care units are usually more susceptible to infection because of underlying diseases or conditions associated with impaired immunity, such as cancer, trauma or advanced age, or because of immunosuppressioin associated with malnutrition or therapy with corticosteroids, cancer chemotherapeutic agents or immunosuppressive drugs Broad-spectrum antimicrobial agents – administered to the majority of Intensive care unit (ICU) patients for treatment of community-acquired or prophylaxis or treatment of nosocomial infections – increase the likelihood of subsequent colonization or infection by antibiotic-resistant pathogens.
Health-care-associated infection (HAI) is a major global safety concern for both patients and health-care professionals. HAI is defined as an infection occurring in a patient during the process of care in a hospital or other health-care facility that was not manifest or incubating at the time of admission. This includes infections acquired in the hospital and any other setting where patients receive health care and may appear even after discharge. HAI also includes occupational infections among facility staff.
Ventilator-associated pneumonia (VAP), that occurs 48–72 hours or thereafter following endotracheal intubation, characterized by the presence of a new or progressive infiltrate, signs of systemic infection (fever, altered white blood cell count), changes in sputum characteristics, and detection of a causative agent. VAP contributes to approximately half of all cases of hospital-acquired pneumonia.
Catheter-related bloodstream infection (CRBSI) is defined as the presence of bacteremia originating from an intravenous catheter. It is one of the most frequent, lethal, and costly complications of central venous catheterization and also the most common cause of nosocomial bacteremia. Central venous catheters (CVCs) pose a greater risk of device-related infections than any other types of medical device and are major causes of morbidity and mortality. They are also the main source of bacteremia and septicemia in hospitalized patients. Majority of CRBSIs are associated with CVCs and in prospective studies, the relative risk for CRBSI is greater with CVCs than with peripheral venous catheters.
Catheter acquired urinary tract infection is one of the most common health care acquired infections, these infections are attributable to use of an indwelling urethral catheter. Indwelling urethral catheter use is exceedingly common in health care facilities. Prevention of infections attributable to these devices is an important goal of health-care infection prevention programs. Indwelling urinary catheters are generally considered to be short term if they are in situ for less than 30 days and chronic or long term when in situ for 30 days or more.
Nowadays infection prevention and control program become a basic component of most healthcare systems and patient safety programs and it is main requirement for accreditation.(e.g. since 1976 the Joint Commission on Accreditation of Healthcare Organizations instituted the requirement that a hospital must have an infection control program in place in order to receive accreditation.
Antimicrobial therapy for the critically ill has increasingly become more complicated and challenging because of escalation in the rates of antimicrobial resistance and increases in patients’ severity of illness and overall complexity. Rates of nosocomial infection and antibiotic resistance are much higher in the intensive care unit (ICU) compared with other units in the hospital.
Antimicrobial stewardship refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobial agents by promoting the selection of the optimal antimicrobial drug regimen including dosing, duration of therapy, and route of administration. The major objectives of antimicrobial stewardship are to achieve best clinical outcomes related to antimicrobial use while minimizing toxicity and other adverse events, thereby limiting the selective pressure on bacterial populations that drives the emergence of antimicrobial-resistant strains. Antimicrobial stewardship may also reduce excessive costs attributable to suboptimal antimicrobial use.
Conclusion
Antimicrobial therapy for the critically ill has increasingly become more complicated and challenging because of escalation in the rates of antimicrobial resistance and increases in patients’ severity of illness and overall complexity. The appropriate use of antimicrobial agents by promoting the selection of the optimal antimicrobial drug regimen including dosing, duration of therapy, and route of administration is the major objective to achieve best clinical outcomes related to antimicrobial use while minimizing toxicity and other adverse events, thereby limiting the selective pressure on bacterial populations that drives the emergence of antimicrobial-resistant strains.