Therapy of infection

Abstract The five basic principles behind the concept of the treatment of an established infection are as follows: •surveillance and diagnostic cultures to ensure identification of the micro-organism so that modification of the otherwise ‘blind' treatment can be undertaken; •immediate and adequate antibiotic treatment in order to sterilize the infected internal organs; •the source of potential pathogens causing the infection — whether endogenous or exogenous — requires elimination for both the recovery of the original infection and the prevention of relapses and/or superinfections. Selective decontamination of the digestive tract (SDD) aims at the eradication of of the oropharynx and gut in patients, whilst identification and eradication of the outside the patients, using disposables and/or hygiene, are an integral part of the therapy of infection; •removal or replacement of invasive devices often contaminated with the potential pathogen is thought to contribute to the healing in curtailing the supply of micro-organisms; •surveillance samples are indispensable in evaluating the efficacy of this five component protocol. The treatment of practically all infections relies on these five basics, in particular lower airway and blood stream infections developing in the critically ill requiring intensive care including mechanical ventilation. Special attention is given in this chapter to the underestimated problem of exogenous infections due to intensive care unit (ICU) associated bacteria without preceding carriage, and to the increasing problem of the serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA).