Principles of Critical Care > Part V. Infectious Disorders > Chapter 49. Endocarditis and Other Intravascular Infections James M. Sizemore, Jr.,  C. Glenn Cobbs,  Mark B. Carr

Key Points

"Patients hospitalized in ICUs may have an intravascular infectious disorder as their primary problem, as a complication of their main disorder, or as a nosocomial infection occurring during their stay. Specific populations common to the ICU, including hemodialysis patients, injection drug users, HIV-infected patients, and those with congenital heart disease, are at increased risk of intravascular infection. Furthermore, violation of anatomic barriers by indwelling intravascular devices and by surgery, as well as impairment of cellular or humoral immune function related to critical illness, contributes to invasion by a variety of microbial pathogens. Infections of intravascular foreign bodies or native vascular structures themselves are likely to be associated not only with symptoms and signs of local inflammation but also with evidence of disseminated disease due to metastatic spread of infectious agents. This chapter provides the clinician caring for patients in an ICU with an approach to the patient with suspected or proved intravascular infectious disorders. We will emphasize the underlying clinical situations that predispose to intravascular infection, the pathogenesis of the disorders, the symptoms and signs of disease, and the appropriate diagnostic procedures, particularly those that provide assistance in the choice of antimicrobial therapy and selection of ancillary medical and surgical procedures. Table 49-1 lists the intravascular infections of native vessels and those associated with intravascular devices, respectively...."