Early detection, prevention and management of bacterial infections in the intensive care unit

Abstract

Bacterial infections occur frequently in intensive care units (ICU) across the world. Their prevalence has relevant impacts on diagnostic approaches, patient treatment concepts and subsequent patient outcomes. In this habilitation, the role and manifestation of bacterial
surface and device contamination potentially affecting critically ill patients with coronavirus disease 2019 (COVID-19) as well as appropriate diagnostic and management strategies with hospital epidemiological consequences during a novel pandemic are discussed. The work demonstrates that bacterial superinfections in critically ill COVID-19 patients with acute respiratory distress syndrome are frequent and commonly associated with longer duration of invasive mechanical ventilation. It highlights the substantial potential of structured microbiological sampling procedures and thorough antibiotic stewardship, in order to prevent the spread of multidrug resistant bacteria. Furthermore, potential benefits of the application of intravenous immunoglobulins as an early management strategy to treat necrotizing soft tissue infections (NSTI) are analyzed in a structured ICU patient cohort with a rare bacterial disease. To analyze a further specific management and prevention approach, this work characterizes the visual behaviour of critical care nurses while identifying drug labels of relevant ICU medications in a setting where performing under time pressure and the avoidance of medication errors - such as in patients with bacterial infections - are key. Together, the results of the presented work demonstrate the importance of accurate diagnostic, prevention and treatment strategies in the vulnerable collective of ICU patients with bacterial infections.