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La neumonia es la segunda complicacion infecciosa en frecuencia en el medio hospitalario, y ocupa el primer lugar en los servicios de medicina intensiva (unidades de cuidados intensivos [UCI]). El 80% de los episodios de neumonia nosocomial se produce en pacientes con via aerea artifical y se denomina neumonia asociada a la ventilacion mecanica (NAV). La NAV es la causa mas frecuente de mortalidad entre las infecciones nosocomiales en las UCI, principalmente si son debidas a Pseudomonas aeruginosa y Staphylococcus aureus resistente a meticilina (MRSA). Ademas, incrementa los dias de ventilacion mecanica y la estancia media en la UCI y el hospital. A pesar de las pruebas disponibles, el diagnostico de una NAV sigue siendo clinico. La presencia de una opacidad en la radiografia de torax y secreciones traqueales purulentas son condiciones imprescindibles para su diagnostico. Ademas, deberemos evaluar su estado y los factores de riesgo para patogenos de dificil tratamiento. Si la NAV es temprana y no existen estos factores de riesgo, la mayoria de las pautas empiricas presentan una cobertura correcta de la flora que nos encontraremos. Sin embargo, si el diagnostico de NAV se realiza en un paciente con mas de 1 semana de ventilacion mecanica, en tratamiento antibiotico o con factores de riesgo, deberemos individualizar la pauta.

Severe sepsis and septic shock are common causes of death in intensive care units (ICU). The incidence of sepsis has been increasing over the past two decades, and is expected to continue rising during the next few years. Despite the fact that we know much about the complex pathophysiologic alterations that occur in severe sepsis and septic shock, patients with sepsis remain at a high risk of death. However, in the last few years, new treatment strategies have significantly improved patient outcome. This article reviews nine major studies published during 2004 and 2005: two deal with incidence rates, distribution of pathogens and trends in antibiotic resistance among ICU patients with sepsis; two discuss selected aspects of antibiotic therapy, the usefulness of combination therapy for sepsis in immunocompetent patients and the impact of empirical treatment in Pseudomonas aeruginosa bloodstream infections; two consider the usefulness of risk assessment in the management of sepsis and the importance of dynamic clinical evolution of critically ill patients with infection. The remaining three studies analyze adjunctive therapy in severe sepsis: the effect of an intensive glucose-management protocol on the outcome of critically ill patients; the evaluation of relative adrenal insufficiency and the variability of cortisol plasma concentrations over a 24-hour period; and the use of Drotrecogin alfa (Activated) for adults with severe sepsis and a low risk of death.

Hospital-acquired infections are a leading cause of morbidity and mortality, especially in the intensive care unit (ICU). Surveillance of device-associated infections plays a major role in infection control programs. In 2006, the Surveillance Program of Nosocomial Infections in Catalonia (VINCat Program) was started, with the major aim of reducing infection rates through a process of active monitoring. The study period comprised calendar years 2008 (with 21 ICUs participating), 2009 (with 21 ICUs participating), and 2010 (with 28 ICUs participating). Each participating hospital was required to have an infection control team made up of at least one physician, an infection surveillance nurse, and a microbiology laboratory. Hospitals were classified into three groups according to their size. Central venous catheter-associated bloodstream infection (CVC-BSI) and ventilator-associated pneumonia (VAP) were chosen as the device-associated infections to analyze. Incidence rates of device-associated infections were calculated by dividing the total number of device-associated infection (VAP or CVC-BSI) days by the total number of days use for the relevant device. Mechanical ventilation use ranged from 0.10 to 0.85 days (overall, 0.35), and central venous catheter use ranged from 0.18 to 0.98 days (overall, 0.65). Incidence rates of VAP ranged from 7.2 ± 3.7 to 10.7 ± 9.6 episodes of VAP/1000 ventilator days. Incidence rates of CVC-BSl ranged from 1.9 ± 1.6 to 2.7 ± 2.0 episodes of CVC-associated bloodstream infection/1000 central venous catheter days. The implementation of the VINCat Program allowed monitoring of nosocomial device-associated infections in ICUs in Catalonia and enabled corrective measures in ICUs with increased incidences of device-associated infections.