Skip to Main Content

++

KEY POINTS

++

  • In addition to immunologic mechanisms, physical (motility), chemical (gastric acidity), and microbiologic (normal colonizing flora) factors normally protect the gastrointestinal tract against infection.

  • Esophagitis, most commonly caused by Candida albicans or herpes simplex virus, may be underrecognized among patients in the intensive care unit.

  • Infection with Helicobacter pylori may play a role in the pathogenesis of gastric stress ulceration among critically ill patients.

  • The epidemiology and microbiology of diarrheal illness is significantly different among patients in the critical care unit than is observed in the community setting. Most infectious diarrhea is hospital acquired and is usually attributable to Clostridium difficile.

  • A systematic approach to the critically ill patient with diarrhea includes consideration of pathogens that cause noninflammatory, inflammatory, and hemorrhagic diarrhea. Thorough history taking supplements laboratory data in the diagnosis of these patients.

  • C difficile infection is the single most common cause of gastrointestinal infection among patients in the intensive care unit. The spectrum of disease induced by C difficile infection is broad. Timely diagnosis and treatment is critical both for the management of the infected patient and to prevent the spread of infection through the unit.

++

While rarely severe enough to warrant admission to the intensive care unit, gastrointestinal infections account for substantial morbidity and mortality among critically ill patients. Because of severe comorbid disease, impaired immune defenses, and the invasive interventions to which they are subjected, patients in the ICU are especially susceptible to hospital-acquired GI infection. Nevertheless, despite the frequency with which these infections occur, the morbidity and mortality that they cause, and the costs they incur, GI infections can go undetected and untreated in the ICU. While trying to manage patients with deteriorating cardiac function, marginal ventilatory performance, and life-threatening metabolic abnormalities, clinicians in the ICU may fail to recognize the important early signs of GI infection.

++

Any discussion of GI infections among critically ill patients must begin with a consideration of the host defenses that normally protect the alimentary tract. As such, the first section of this chapter is devoted to a description of the unique nonimmunologic mechanisms normally active in the GI tract. Particular consideration is given to the means by which these defenses may be compromised in patients in the ICU. Following this introduction, the clinical manifestations of infection affecting each segment of the GI tract are discussed (Table 76-1). In addition to describing the microbiology associated with each syndrome, a rational diagnostic and therapeutic approach is offered, based on the most up-to-date experience reported in the medical literature. The chapter concludes with an expanded discussion of the unique clinical challenges presented by the patient in the ICU with Clostridium difficile infection.

++
Table Graphic Jump Location
TABLE 76-1

Clinical Manifestations of Infection of Different Segments of the Gastrointestinal Tract

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

Create a Free MyAccess Profile

* Required Fields

Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.

Passwords must be between 6 and 40 characters long (no whitespace), cannot contain characters #, &, and must contain:
  • at least one lowercase letter
  • at least one uppercase letter
  • at least one digit

Benefits of a MyAccess Profile:

  • Remote access to the site off-campus on any device
  • Notification of new content via custom alerts
  • Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
  • Save and download images to PowerPoint
  • Self-Assessment quizzes saved for quick review
  • Custom Curriculum access for both instructors and learners

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.