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CHAPTER 76: Gastrointestinal Infections and Clostridium Difficile 703

Manipulations of the bag and catheter should be kept to a mini-
mum. The bag should always be kept below the level of the bladder • Stovall RT, Haenal JB, Jenkins TC, et al. A negative urinalysis rules
to facilitate gravitational drainage. Once in place there is no need out catheter-associated urinary tract infection in trauma patients
for regular scheduled replacements of the catheter, which can be left in the intensive care unit. J Am Coll Surg. 2013;217(1):162-166.
indefinitely, provided it is functioning well and there are no encrusta- • Tambyah PA, Maki DG. Catheter-associated urinary tract infec-
tions. Short-term urinary catheters impregnated with silver alloy or tion is rarely symptomatic: a prospective study of 1,497 catheter-
nitrofurazone (an analogue of nitrofurantoin) have been shown to ized patients. Arch Intern Med. March 13, 2000;160(5):678-682.
prevent asymptomatic CAB in studies of modest quality, but have not • Zarkotou O, Pournaras S, Voulgari E, et al. Risk factors and
been shown to prevent symptomatic UTI. A survey of US hospitals outcomes associated with acquisition of colistin-resistant KPC-
showed that that they were in use in 30% of hospitals. We do not rec- producing Klebsiella pneumoniae: a matched case-control study.
ommend them due to questionable efficacy, and lack of demonstrable J Clin Microbiol. June 2010;48(6):2271-2274.
cost-effectiveness. 13,92,93

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KEY REFERENCES Complete references available online at www.mhprofessional.com/hall
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• Bougnoux ME, Kac G, Aegerter P, d’Enfert C, Fagon JY. Candidemia CHAPTER Gastrointestinal Infections
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• Fisher JF, Kavanagh K, Sobel JD, Kauffman CA, Newman CA. • In addition to immunologic mechanisms, physical (motility), chem-
Candida urinary tract infection: pathogenesis. Clin Infect Dis. ical (gastric acidity), and microbiologic (normal colonizing flora)
May 2011;52(suppl 6):S437-S451. factors normally protect the gastrointestinal tract against infection.
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• Johnson JR, Johnston B, Clabots C, Kuskowski MA, Castanheira M. ing supplements laboratory data in the diagnosis of these patients.
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Clin Infect Dis. August 1, 2010;51(3):286-294. of disease induced by C difficile infection is broad. Timely diagnosis
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• Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a While rarely severe enough to warrant admission to the intensive care
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Infect Dis. September 2010;10(9):597-602. disease, impaired immune defenses, and the invasive interventions to
• Laupland K, Bagshaw S, Gregson D, Kirkpatrick A, Ross T, which they are subjected, patients in the ICU are especially susceptible
Church D. Intensive care unit-acquired urinary tract infections to hospital-acquired GI infection. Nevertheless, despite the frequency
in a regional critical care system. Crit Care. 2005;9(2):R60-R65. with which these infections occur, the morbidity and mortality that they
• Livermore DM, Hope R, Brick G, Lillie M, Reynolds R. Non- cause, and the costs they incur, GI infections can go undetected and
susceptibility trends among Enterobacteriaceae from bacterae- untreated in the ICU. While trying to manage patients with deteriorating
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November 2008;62(suppl 2):ii41-ii54. metabolic abnormalities, clinicians in the ICU may fail to recognize the
important early signs of GI infection.

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