In 2010, in the general medical or surgical intensive care unit (ICU), complications of infection, manifested as sepsis and multiple organ failure, are the number one cause of morbidity and mortality. Infections are also a significant contributor to adverse outcomes and mortality in burn, cardiothoracic and neurosurgical ICUs. Even coronary care units increasingly contain a more medical ICU-type population with greater concomitant infection risks. The reasons are multifactorial. Advances in medicine, surgery, interventional radiology and anesthesia have eliminated or shortened hospital stays. Hospital wards and hence ICUs contain relatively sicker patients that commonly have several significant organ system diseases. An aging population receiving complex, often invasive, life-sustaining therapies, transplantation, immunomodulation and invasive methods of monitoring and therapeutics delivery has resulted in a more immunosuppressed ICU patient population at greater risk of infection and organ failure. The infecting organisms themselves are becoming more virulent (e.g., Clostridium difficile) or resistant to antimicrobial agents (e.g., multidrug-resistant Klebsiella). Concerns about hospital-acquired infections have further heightened the scrutiny paid to preventable and presumably preventable nosocomial or healthcare-associated infections with increasing accountability, including potential financial penalties, placed on hospital administration and ICU personnel. The need for greater expertise in infectious diseases for critical care physicians, whose main concerns center on resuscitation, life support and monitoring, has never been greater. It is in this environment that the third and latest edition of ‘Infectious Diseases in Critical Care Medicine’ has been released.
The book is highly readable, clinically oriented and very relevant to the bedside practice of critical care. At 581 pages long, it contains 31 chapters organized into four sections written by nationally and internationally recognized teacher–clinicians. A guidelines approach is purposefully avoided and the style is evidence based, but tempered by clinical experience. The overall theme created by the editor is an emphasis on making the most accurate and optimal differential diagnosis possible at the outset, so that laboratory testing can be streamlined and empiric antimicrobial therapy can be more focused, with the treatment of noninfectious mimics of infection minimized to limit broad-spectrum or unnecessary antibiotic prescription. Limiting resistance problems and appreciating the resistance potential of common antibiotics is stressed throughout this work. All of the chapters contain ubiquitous clinical pearls and many tables summarize or supplement information in the text. The photos are black and white, except for color plates used in the chapter on ophthalmological clues.
The first section entitled ‘Diagnostic Approach in Critical Care’ contains chapters on the clinical approach to fever, fever and rash, physical exam clues, ophthalmological clues and radiology of infectious diseases, all with an emphasis on critical care and identifying the mimics of infection. The final chapter of this section ‘How to Differentiate Methicillin Resistant Staphylococcus Aureus/Vancomycin Resistant Enterococci Colonization and Infection in the Critical Care Unit’ is an example of the problem-oriented, critical care relevant approach used throughout the book. The second section ‘Clinical Syndromes in Critical Care’ contains chapters on the clinical approach to sepsis, meningitis, encephalitis, severe community-acquired pneumonia, nosocomial pneumonia, intravenous central-line infections, infective endocarditis, intra-abdominal surgical infections, C. difficile infection, urosepsis, and severe skin and soft-tissue infections. Again, the emphasis in most of the chapters is on differentiating infection from its noninfectious mimics in critical care. The third section of the book, ‘Difficult Diagnostic Problems in Critical Care’ deals with tropical infections, infections in cirrhosis, severe infections in asplenic patients, infections in burns, infections related to steroids and immunosuppressive/immunomodulating agents, miliary TB and bioterrorism, the longest chapter in the book. The fourth and final section on antimicrobial therapy includes chapters on antibiotic selection, antimicrobial therapy of vancomycin-resistant Enterococcus and methicillin-resistant S. aureus, multidrug-resistant Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii, antibiotic kinetics, antibiotic therapy in the penicillin-allergic patient and adverse reactions to antibiotics, again all written in the context of critical care.
Some minor criticisms include the lack of chapters dedicated to viral or fungal infections, although they are discussed where appropriate within various chapters. It is also curious, and inconsistent with the overall style, that there are no noninfectious mimics discussed in the nosocomial pneumonia chapter, especially considering that ventilator-associated pneumonia (VAP) is easily overdiagnosed in patients after surgery and trauma because they are particularly susceptible to noninfectious (i.e., no pulmonary infection, possible sepsis originating below diaphragm) acute lung injury that is falsely attributed to VAP. Furthermore, a discussion of the diagnostic limitations of computerized tomography in the diagnosis of intra-abdominal sepsis in the postsurgical abdomen, a highly challenging but common scenario in the general surgical ICU, would have been welcome.
As any practicing bedside intensivist knows, reliance on strict guidelines and evidence-based literature alone do not make a particularly safe or effective clinician. This text goes a long way toward providing the reader with the elements of a more seasoned approach that can lead to earlier and more accurate diagnosis of infectious problems in the ICU and more appropriate antimicrobial selection with less indiscriminate empiric antibiotic use. Critical care physicians, infectious disease specialists that consult in the ICU, and both infectious disease and critical care fellows in training will benefit the most from the wisdom contained within this excellent book.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.