Infections as a problem in the intensive care unit.

Problems of infections in the intensive care unit (ICU) center on patients admitted because of sepsis, patients with compromised host defenses and patients subject to invasive procedures. The mortality rate in septic shock is high, 47% in our own study. Escherichia coli was found in half the cases. Multiple organ failure is often the common denominator in patients with sepsis. Hypovolaemia and low serum proteins make the patients more susceptible to infections. Typical ICU procedure, i.e. central venous catheters, arterial lines, Swan-Ganz catheters, endotracheal tubes and urinary catheters violate natural bacterial defence barriers and may be a source of infection. Use of corticosteroids and cimetidine may impair defence mechanisms. The use and abuse of antibiotics is vital to the successful control and treatment of infections in the ICU. Infection has been quoted as the most important single factor which determines the outcome of the intensive care patient.