Surgical Intensivist Ghent University Hospital, Belgium
Infection is a leading cause of morbidity and mortality in the critically ill, yet many ICU patients are admitted, treated empirically, and recover or die, all without clinicians definitively identifying their source of infection. Broad treatment of syndromes such as "sepsis" leads to an imperfect therapeutic approach at best, and misdiagnosis and mistreatment at worst. A rational approach to the infectious workup that considers diagnostic abnormalities, organ involvement, tempo of disease course, history and risk factors, and diagnostic "excluders" is necessary to construct an accurate differential and identify the most likely culprit. We offer a practical approach to this common scenario from the perspective of the infectious disease specialist, suggest some useful principles to apply in the ICU, and highlight common errors.
