Top 100 ICU Papers – Infection


Kumar A, Roberts D, Wood KE, Light B, Parrillo JE et al.
Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock.
CCM 2006,34,1589-1596 Kumar
Door-to-antibiotic time: “time is cytokine”!


Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S et al.
An intervention to decrease catheter-related bloodstream infections in the ICU.
NEJM 2006,355,2725-2732 Pronovost.
Wow. Why would implementing good aseptic technique cause such an ethical controversy?

De Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF et al.
Decontamination of the digestive tract and oropharynx in ICU patients.
NEJM 2009,360,20-31 DeSmet
How much more evidence do we need to start doing SDD routinely?


Chan EY, Ruest A, Meade MO, Cook DJ.
Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis.
BMJ 2007,334,889 Chan
Halves the incidence of VAP, but no change in mortality or length-of-stay.


Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret GY.
Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis.
Critical Care Medicine 2006; 34: 1996-2003.
It all depends on which meta-analysis you read (or how high your standards are….)
PubMed Abstract

Bai Y, Gao J, Zou DW, Li ZS.
Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis: evidence from a meta-analysis of randomized controlled trials.
American Journal of Gastroenterology 2008; 103: 104-10. PubMed Abstract
Once again, it all depends on whichmeta-analysis you read…

Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H et al.; Dutch Acute Pancreatitis Study Group.
Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial.
Lancet 2008,371,651-659 Besselink
Well, we may not be sure about antibiotics, but at least we know where we stand on probiotics!


Watkinson PJ, Barber VS, Dark P, Young JD.
The use of pre-, pro- and synbiotics in adult intensive care unit patients: Systematic review.
Clinical Nutrition 2007; 26: 182-92 PubMed Abstract
No more yoghurt for you, Mrs Robinson……………..

Shittu A, Lin J
Newer anti-staphylococcal agents: in-vitro studies and emerging trends in Staphylococcus aureus resistance
Wounds 2006; 18: 129-146 Wounds Full Text
New antibiotics coming soon to an ICU near you – but how long until that devious Staph finds a new anti-antibiotic?

Playford EG, Webster AC, Sorrell TC, Craig JC.
Antifungal agents for preventing fungal infections in non-neutropenic critically ill and surgical patients: systematic review and meta-analysis of randomized clinical trials.
Journal of Antimicrobial Chemotherapy 2006; 57: 628-38 PubMed Abstract
Add to that not one but two meta-analyses on (nearly) the same subject from CCM, and you have a hottopic……….. Cochrane Full Text

Huang L, Quartin A, Jones D, Havlir DV.
Intensive care of patients with HIV infection.
NEJM 2006,355,173-181 Huang
A ‘hot topic’ from the 2006 exam – two months before this review came out!

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