Despite improvement in some hygiene measures, nosocomial infections remain an important and widespread problem. In particular, the emergence of multiresistant organisms has even led to the temporary closure of some units. Belatedly, more rapid screening tools and diagnostic techniques based on molecular probes are being developed, which should facilitate early identification of pathogens, resulting perhaps in more effective isolation of patients and earlier institution of targeted antibiotics. Development in imaging techniques has considerably improved identification of the source of infection, and the need for “empirical laparotomies” has almost disappeared. in detail
Guidelines are being increasingly developed to limit the extended use of antibiotics and to narrow the spectrum of activity or stop antibiotics after 3 to 4 days depending on the identification (or not) of pathogens, sensitivity patterns, and clinical response. Selective decontamination of the digestive tract has been shown to decrease pneumonia and probably mortality but is not used widely, primarily because of costs and the fears of long-term bacterial resistance. Nursing patients with the head of the bed elevated at 45° can decrease the incidence of gastroesophageal reflux in patients receiving mechanical ventilation, and may reduce the development of nosocomial pneumonia. The use of antibiotic-coated catheters has decreased the incidence of catheter-related infections.
We now understand much more about the pathophysiology of sepsis and sepsis-related syndromes, although there are still many gaps in our knowledge. We recognize that sepsis represents an exaggerated systemic inflammatory response triggered by infection rather than a direct attack on the tissues by microorganisms that antibiotics may or may not kill. We now realize that the development of multiple organ failure involves multiple pathways including inflammatory, immune, microvascular, hormonal, bioenergetic, and metabolic systems.