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Infections and their complications are a very important clinical
area in the intensive care unit setting. Community-acquired
infections and nosocomial infections both contribute to the high
level of disease acquisition common among critically ill patients.
The accurate diagnosis of nosocomial infections and the provision
of appropriate therapies, including antimicrobial therapy effective
against the identified agents of infection, have been shown to be
important determinants of patient outcome.
Critical care practitioners are in a unique position in dealing
with infectious diseases. They are often the initial providers of
care to seriously ill patients with infections. Additionally, they
have a responsibility to ensure that nosocomial infections are
prevented and that antimicrobial resistance is minimized by
prudently employing antibiotic agents. It is the editors' hope that
this book will provide clinicians practicing in the intensive care
unit with a reference to help guide their care of infected
patients. To that end they have brought together a group of
international authors to address important topics related to
infectious diseases for the critical care practitioner.
Sepsis is a very important public health problem. It is widely
acknowledged that the severe inflammatory response syndrome/severe
sepsis paradigm fails to stratify sepsis patients adequately. This
book reviews in detail how sepsis should be managed on the basis of
a novel approach to staging. The PIRO (predisposing factors,
infection, response, organ dysfunction) model was first proposed at
the start of the decade on a theoretical basis and has now been
translated into a practical approach for use at the bedside. It is
loosely based on the TNM staging system for cancers, with points
being allocated to each of the four aforementioned key
characteristics of the septic process. The proposed PIRO framework
facilitates evaluation of factors that are important in the
pathogenesis of severe sepsis and in the development of treatment
strategies. This book clearly explains the advantages of the PIRO
approach in different settings and will be of value to all
practitioners concerned with the management of sepsis.
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