Management and control of infectious complications

P atients admitted to a cardiovascular intensive care unit (CV-ICU) are at risk for infectious complications. In fact, the likelihood is fourfold higher compared with the usual hospital ward.’ A number of host factors predispose patients to infections. These include age, severity of underlying cardiopulmonary disease, diabetes mellitus, malnutrition, and obesity. Patients have usually received perioperative antibiotics that predispose them to infections caused by multiple-resistant bacteria and fungi. Drugs such as corticosteroids, cyclosporine, and azothiaprim further suppress immune function, which has already been reduced by the stress of major surgery. Finally, a natural breakdown of normal physical and physiologic barriers occurs by a surgical wound, and such factors as intubation and placement of nasogastric tubes, vascular lines, and urinary catheters. Unresponsive patients are prone to develop pressure sores on dependent areas. These can result in decubitus ulcers if patients remain bedfast for prolonged periods. The use of antacid prophylaxis to prevent upper gastrointestinal stress ulcers breaks a physiologic barrier. Loss of stomach acid results in heavy colonization of bacteria, especially gram-negative rods. Recolonization of the patient with transient nosocomial pathogens comes from a variety of sources. A recent study showed that Pseun however, with a gastric pH 2 4, the colonization rate rose to 59%.