Topics in Anaesthesia and Critical Care

H.K.F. VANVV SAENE, L. SILVESTRI, M.A. DE LA CAL (EDS)Infection Control in the Intensive Care Unit1998, 380 pp, ISBN 3-540-75043-6J. MILIC-EMILI (ED)Applied Physiology in Respiratory Mechanics1998, 246 pp, ISBN 3-540-75041-XG. GUARNIERI, F. ISCRA (EDS)Metabolism and Artificial Nutrition in the Critically III1999,130 pp, ISBN 88-470-0042-4J. MILIC-EMILI, U. LUCANGELO, A. PESENTI, W.A. ZIN (EDS)Basics of Respiratory Mechanism and Artificial Ventilation 1999, 268 pp, ISBN 88-470-0046-7M. TIENGO, Y.A. PALADINIPP , N. RAWAL (EDS)Regional Anaesthesia, Analgesia and Pain Management 1999, 362 pp, ISBN 88-470-0044-0I. SALVO, D. VIDYASAGAR (EDS)Anaesthesia and Intensive Care in Neonates and Children 1999,324 pp, ISBN 88-470-0043-2G. BERLOT, H. DTT ELOOZ, A. GULLO (EDS)Trauma Operative Procedures1999, 210 pp, ISBN 88-470-0045-9G.L. ATLEEAA , J.-L. VINCENT (EDS)Critical Care Cardiology in the Perioperative Period2000, 214 pp, ISBN 88-470-0133-1M.A. TIENGO (ED)Neuroscience: Focus on Acute and Chronic Pain2000, 214 pp, ISBN 88-470-0134-XH.K.F. VANVV SAENE, G. SGANGA, L. SILVESTRI (EDS)Infection in the Critically Ill: an Ongoing Challenge2001, 200 pp, ISBN 88-470-0138-2

Anestesia e Medicina Critica

G. SLAVICH (ED)Elettrocardiografia Clinica 1997, 328 pp, ISBN 3-540-75050-9G.L. ALATI, B. ALLARIA, G. BERLOT, A. GTT ULLO, A. LUZZANI,G. MARTINELLI, L. TORELLI (EDS)Anestesia e Malattie Concomitanti - Fisiopatologia e clinica del periodo perioperatorio1997, 381 pp, ISBN 3-540-75048-7B. ALLARIA, M. V. BALDASSARE, A. GULLO, A. LUZZANI,G. MANANI, G. MARTINELLI,A. PASETTOPP , L. TORELLI (EDS)Farmacologia Generale e Speciale in Anestesiologia Clinica1997, 312 pp, ISBN 88-470-0001-7A. GULLO (ED)Anestesia Clinica1998, 506 pp, ISBN 88-470-0038-6A. GULLO, L. GATTINONIMedicina Intensiva e Perioperatoria 2000, 863 pp, ISBN 88-470-0135-8A. GULLOMedicina Perioperatoria, Terapia Intensiva, Emergenza 2003, 604 pp, ISBN 88-470-0215-X

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H.K.F. van SaeneL. SilvestriM.A. De La CalInfection Control in the Intensive Care Unit

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113

H.K.F. van Saene (Editor)L. Silvestri (Editor)M.A. De La Cal (Editor)

Infection Controlin the IntensiveCare UnitSecond Edition

Series edited byAntonino Gullo

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il iH.K.F. Van Saene, M.D. L. Silvestri, M.D.Department of Medical Microbiology Emergency Department and UnitUniversity of Liverpool of Anesthesia and Intensive CareAlder Hey Children’s Hospital, NHS Trust Presidio Ospedaliero of GoriziaLiverpool, UK Gorizia, Italy

M.A. De La Cal, M.D.Department of Critical Care MedicineUniversity Hospital of GetafeMadrid, Spain

Series Topics in Anaesthesia and Critical Care edited byPROF. A. GULLO

Department of Perioperative Medicine, Intensive Care and EmergencyTTrieste University School of Medicine,TTrieste, Italy

Library of Congress Control Number: 2004114978

ISBN 88-470-0185-4 Springer Milan Berlin Heidelberg New York

TThis work is subject to copyright. All rights are reserved, whether the whole or part of thematerial is concerned, specifically the rights of translation, reprinting, reuse of illustrations,recitation, broadcasting, reproduction on microfilm or in any other way, and storage indata banks. Duplication of this publication or parts thereof is permitted only under theprovisions of the Italian Copyright Law in its current version, and permission for use mustalways be obtained from Springer. Violations are liable to prosecution under the ItalianCopyright Law.

Springer is a part of Springer Science+Business Mediaspringeronline.com© Springer-Verlag Italia 2005Printed in Italy

TThe use of general descriptive names, registered names, trademarks,etc. in this publicationdoes not imply, even in the absence of a specific statement, that such names are exemptfrom the relevant protective laws and regulations and therefore free for general use.Product liability: The publisher cannot guarantee the accuracy of any information aboutdosage and application contained in this book. In every individual case the user mustcheck such information by consulting the relevant literature.

Cover design: Simona Colombo, Milan, ItalyTTypesetting: Graphostudio, Milan, ItalyPrinting: Grafiche Porpora, Cernusco S/N, Italy

Vol.Infection Romane 8-02-2005 15:36 Pagina IVginagina

fPreface

Seven years have passed since the first edition of ‘Infection Control in theIntensive Care Unit’ was published. That book was a compilation of the lecturesread at an intensive course on management of infection in the critically illorganised by Professor A. Gullo in Trieste, Italy, and has been completely rewrit-ten by Italian, Spanish, South American, Dutch and Anglo-Canadian authors inthis second edition. The book is up to date, with references to publications from2004. We regard it as important that all statements are justified by the best avail-able evidence. All authors have made efforts to avoid unsubstantiated expertopinion. Although prevention is not entirely separate from therapy, preventionrather than cure is pivotal in this publication.

There are five sections in this second edition. The first section deals withbasics in microbiology specifically as they operate in supporting infection con-trol. Surveillance cultures of throat and rectum are an integral part of themicrobiological approach of this publication. Surveillance cultures are required

fto determine the carrier state. Carriage is indispensable for the classification ofmicro-organisms into low level, high level pathogens and potentially pathogen-ic micro-organisms. This distinction is crucial as prevention methods targetonly potentially pathogenic micro-organisms and high level pathogens. Thefront cover illustrates the usefulness of classifying infections occurring on theintensive care unit [ICU], again using carriage as detected by surveillance cul-tures. Primary endogenous pneumonias are the main infectious problem on theICU, with an incidence of about 55%. Primary endogenous pneumonia causedby potential pathogens, both ‘normal’ and ‘abnormal’, usually occurs within aweek of admission to ICU. Previously healthy individuals including trauma andsurgical patients develop early endogenous pneumonias with the ‘normal’potential pathogens such as Streptococcus pneumoniae, Haemophilus influen-zae, Moraxella catarrhalis and Staphylococcus aureus. Patients with underlyingchronic conditions such as diabetes, alcoholism and chronic obstructive pul-monary disease and who are referred to the ICU from home or from otherwards and hospitals, may carry abnormal aerobic Gram-negative bacilli[AGNB] such as Klebsiella, Acinetobacter and Pseudomonas species in theiradmission flora. This type of patient may develop a primary endogenous pneu-monia with abnormal flora. Fortunately, most patients recover from their pri-mary endogenous pneumonia after intensive care treatment including antibiot-ic therapy. About one third of ICU admissions may develop a late pneumonia,

yusually after the first weeks’ treatment on ICU. These patients invariablyacquire abnormal AGNB, which are associated with the ICU-environment, intheir oropharynx. This leads to secondary carriage and oropharyngeal over-

Vol.Infection Romane 1-02-2005 17:06 Pagina V

growth, migration and colonisation/infection of the lower airways. Thissequence of events is termed secondary endogenous pneumonia because thepneumonia is preceded by oropharyngeal carriage. Finally, P. aeruginosa hasbeen described as possessing an intrinsic tropism to colonise lower airwaysrather than the oropharynx when both sites are equally accessible to bacterialentry. The pathogenesis of this type of pneumonia is termed exogenous becausethe lung is infected by P.aeruginosa after direct inoculation without previouscarriage. The incidence of exogenous lower airway infections is about 15%, andthis exogenous pneumonia can occur at any time during treatment on the ICU.A new chapter not present in the first edition is dedicated to the standard oper-ating procedure of surveillance cultures. How to process surveillance culturesin order to distinguish the ‘normal’ from the ‘abnormal’ carrier state isdescribed in a separate chapter.

The second section deals with antimicrobials both parenteral and enteral.The most recent systemic antibiotics are discussed. Enteral antimicrobials areoften old, but a new chapter on all aspects of enteral non-absorbable antimi-crobials is added to the new edition.

Section three deals with policies, infection control, antibiotic and deviceguidelines. A new addition is the chapter on evidence based infection control.For the first time, 57 outbreaks of infection on ICU - all using molecular tech-niques for outbreak analysis - are carefully analysed and one third found to bepolyclonal rather than, as expected, monoclonal. The four components - par-enteral, enteral antibiotics, hygiene and surveillance cultures as part of selectivedecontamination of the digestive tract - are discussed in a separate chapter.

Section four deals with the infections occurring on neonatal, paediatric andadult ICUs. Infections developing in a particular subset of patients includingthose with trauma, burns, liver transplant and AIDS are part of section four.Compared with the first edition, a new chapter on clinical virology in all threetypes of ICU is inserted. Therapy of infection is based on six principles [i] sur-veillance and diagnostic cultures to identify micro-organisms; [ii] immediateand adequate antibiotic treatment to sterilise the internal organs; [iii] thesource of potential pathogens requires elimination for recovery of the originalinfection and prevention of relapses and/or superinfections; [iv] the use of top-ical antimicrobials such as aerosolised antimicrobials to sterilise the lower air-ways; [v] removal or replacement of the foreign device such as the endotrachealtube; [vi] surveillance samples are indispensable to monitor efficacy of treat-ment. This approach – albeit not always evidence based – is described in a sep-arate chapter.

The last section comprises special topics such as nutrition, gut mucosal pro-tection, the role of the pharmacist in infection control and the control of multi-resistant AGNB and methicillin-resistant Staphylococcus aureus f. The addition ofenteral to parenteral antimicrobials has been shown to be an approach for thecontrol of antimicrobial resistance on the ICU. A five year experience is pre-sented. Evidence based maneuvres on the ICU are analysed in the final chapter.

Preface

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We are very grateful to Lynda Jones and Julie Owens for their superb secre-tarial assistance, to Ken Maddocks for his diagram on the cover page, to Prof.Antonino Gullo for his constructive suggestions, and to Donatella Rizza andCatherine Mazars from Springer for their loyal support.

This second edition is twice the length of the first edition. This is a drawbackbecause good books should be concise, but it is our aim to prune for the third

yedition in 2012. We hope that this book is instructive, is helpful in your dailyclinical practice and that you enjoy it.

H.K.F. van SaeneL. Silvestri

lM.A. de la Cal

VIIPreface

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Contents

SECTION ONEESSENTIALS IN CLINICAL MICROBIOLOGY

Chapter 1Glossary of Terms and DefinitionsR.E. SARGINSON, N. TAYLORTT , M.A. DE LA CAL, H.K.F. VAN SAENE . . . . . . . . . . . . . . 3

Chapter 2CarriageS. ROSSENEU, G. RIOS, P.E. SPRONK, J.J.M. VAN SAENE . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Chapter 3Colonization and InfectionL. SILVESTRI, G. MINO, H.K.F VAN SAENE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Chapter 4Classification of Micro-Organisms According to their PathogenicityM.A. DE LA CAL, E. CERDÀ, A. ABELLA, P. GARCIA-HIERRO . . . . . . . . . . . . . . . . . . . . . 49

Chapter 5Classification of ICU InfectionsL. SILVESTRI, M. VIVIANI, H.K.F. VAN SAENE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Chapter 6Gut Microbiology: Surveillance Samples for the Detectionof the Abnormal Carrier StateH.K.F VAN SAENE, G. IZQUIERDO, P. GARCIA-HIERRO, F. FONTANA . . . . . . . . . . . . . . 73

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SECTION TWOANTIMICROBIALS

Chapter 7Systemic AntibioticsA.R. DE GAUDIO, S. RINALDI, A. NOVELLI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Chapter 8Systemic AntifungalsF. J. COOKE, T. ROGERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

Chapter 9Enteral AntimicrobialsM. SANCHEZ, B.P. PIZER, S.R. ALCOCK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

SECTION THREEINFECTION CONTROL

Chapter 10 Evidence-Based Infection Control in the Intensive Care UnitJ. HUGHES, N. TAYLORTT , E. CERDÀ, M.A. DE LA CAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

Chapter 11Device PoliciesA.R. DE GAUDIO, A. DI FILIPPO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Chapter 12Antibiotic Policies in the Intensive Care UnitH.K.F. VAN SAENE, N.J. REILLY, A.YY DE SILVESTRE, G. NARDI . . . . . . . . . . . . . . . . . . . . . . 231

Chapter 13Outbreaks of Infection in Intensive Care Units-Usefulness of MolecularTechniques for Outbreak AnalysisV. DAMJANOVIC, X. CORBELLA, J.I. VAN DER SPOEL, H.K.F. VAN SAENE . . . . . . . . . . 247

Chapter 14Prevention of Infection Using Selective Decontaminationof the Digestive TractL. SILVESTRI, S. KERR, A. GULLO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297

Contents

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SECTION FOURINFECTIONS ON ICU

Chapter 15Lower Airway InfectionN. FÀBREGAS, A. ALCÓN, A. TORRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315

Chapter 16Bloodstream Infections Including Endocarditis and MeningitisJ. VALLÉSVV , R. FERRER, P. FERNÁNDEZ-VILADRICH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337

Chapter 17Infections of the Peritoneum Including Pancreas, Mediastinum, Pleura,Wounds, and Urinary Tract G. SGANGA, G. BRISINDA, G. MARIA, M. CASTAGNETO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379

Chapter 18Infection on the Neonatal and Pediatric Intensive Care UnitsA.J. PETROS, V. DAMJANOVIC, A. PIGNA, J. FARIASFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415

Chapter 19Immediate Adequate Antibiotics control Morbidity and Mortality in Patients with Pancreatitis, Extensive Burns, Trauma, ExacerbatedChronic Obstructive Pulmonary Disease, or Liver TransplantationI. ALÍA, M.A. DE LA CAL, E. CERDÁ, H.K.F. VAN SAENE . . . . . . . . . . . . . . . . . . . . . . . . . . 429

Chapter 20Intensive Care Unit Patients following TransplantationA. MARTÍNEZ-PELLÚS, M. PALOMARPP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455

Chapter 21Clinical Virology in NICU, PICU and Adult ICUW. TONG, S. SCHELENZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469

Chapter 22AIDS Patients in the Intensive Care UnitL. ALVAREZ-ROCHA, P. RASCADO-SEDES, J. PASTORPP -BENAVENT,TT

F. BARCENILLA-GAITE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495

Chapter 23Therapy of InfectionJ.H. ROMMES, A. SELBY, D.F. ZYY ANDSTRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515

XIContents

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SECTION FIVESPECIAL TOPICS

Chapter 24SIRS, Sepsis, and MODSG. BERLOT, A. TTT OMASINI, M. VIVIANI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537

Chapter 25SIRS/Sepsis: Metabolic and Nutritional Changes and TreatmentF. ISCRA, A. RANDINO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 549

Chapter 26Gut Mucosal Protection in the Critically Ill Patient.Towards an Integrated Clinical Strategy D. F. ZANDSTRA, P.H.J. VAN DER VOORT, K. TTT HORBURN, H.K.F. VAN SAENE . . . . 565

Chapter 27Selective Decontamination of the Digestive Tract:the Role of the PharmacistN.J. REILLY, A.J. NYY UNN, K. POLLOCK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575

Chapter 28Antimicrobial Resistance: a Prospective 5-Year StudyH.K.F. VAN SAENE, N. TAYLORTT , N.J. REILLY, P.B. BYY AINES . . . . . . . . . . . . . . . . . . . . . . . . . 593

Chapter 29ICU-Acquired Infection: Mortality, Morbidity, and CostsJ.C. MARSHALL, K.A.M. MARSHALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605

Chapter 30Evidence-Based Medicine in the Intensive Care UnitA.J. PETROS, K.G. LOWRY, H.K.F.YY VAN SAENE, J.C. MARSHALL . . . . . . . . . . . . . . . . . . . 621

Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 635

XII Contents

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Abella A.Department of Critical Care Medicine, Hospital Universitario de Getafe,Madrid, Spain

Alcock S.R.Department of Bacteriology, Western Infirmary Glasgow, Glasgow, UK

Alcón A.Anesthesiology Department, Surgical Intensive Care Unit, URSC, Hospital Clínic,Universitat de Barcelona, Barcelona, Spain

Alía I.Department of Critical Care Medicine, Hospital Universitario de Getafe,Madrid, Spain

Alvarez-Rocha L.Intensive Care Unit, Juan Canalejo Hospital, Coruña, Spain

Baines P.B.Pediatric Intensive Care Unit, Alder Hey Children’s Hospital, Liverpool, UK

Barcenilla-Gaite F.Intensive Care Unit, Arnau de Vilanova Hospital, Lleida, Spain

Berlot G.Department of Anaesthesia, Perioperative Medicine, Intensive Care andEmergency, University Hospital School of Medicine, Trieste, Italy

Brisinda G.Surgery and Transplantation Unit, Policlinico Universitario Agostino Gemelli,Rome, Italy

Castagneto G.Surgery and Transplantation Unit, Policlinico Universitario Agostino Gemelli,Rome, Italy

Contributors

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Cerda E.Department of Critical Care Medicine, Hospital Universitario de Getafe,Madrid, Spain

Cooke F.J.Division of Microbiology, Hammersmith Hospital, London, UK

Corbella X.Department of Intensive Care, University of Barcelona, Barcelona, Spain

Damjanovic V.Department of Medical Microbiology, University of Liverpool,Liverpool, UK

De Gaudio A.R.Department of Anesthesia and Critical Care, University of Florence,Florence, Italy

de la Cal M.A.Department of Critical Care Medicine, Hospital Universitario de Getafe,Madrid, Spain

de Silvestre A.Department of Anaesthesia and Intensive Care, University Hospital ofS. Maria della Misericordia, Udine, Italy

Di Filippo A.Section of Anesthesiology and Intensive Care, Department of Critical Care,University of Florence, Florence, Italy

Fàbregas N.Anesthesiology Department, Surgical Intensive Care Unit, URSC, Hospital Clínic,Universitat de Barcelona, Barcelona, Spain

Farias J.Pediatric Intensive Care Unit, Children’s Hospital Ricardo Gutierrez,Buenos Aires, Argentina

Ferrer R.Intensive Care Department, Hospital Sabadell, Sabadell, Spain

Fernández-Viladrich P.F.Infectious Diseases Department, Hospital Bellvitge,Barcelona, Spain

XIV Contributors

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Fontana F.Department of Medical Microbiology, University Hospital of Gorizia,Gorizia, Italy

Garcia-Hierro P.Department of Medical Microbiology, University Hospital of Getafe,Madrid, Spain

Gullo A.Department of Perioperative Medicine, Intensive Care and Emergency, Universityof Trieste, Cattinara Hospital, Trieste, Italy

Hughes J.Department of Clinical Microbiology and Infection Control, University HospitalAintree, Liverpool, UK

Iscra F.Department of Perioperative Medicine, Intensive Care and Emergency,University of Trieste, Cattinara Hospital, Trieste, Italy

Izquierdo G.Department of Medical Microbiology, University of Trujillo, Peru

Kerr S.Department of Pediatric Intensive Care, Alder Hey Children’s Hospital,Liverpool, UK

Lowry K.G.Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland

Maria G.Surgery and Transplantation Unit, Policlinico Universitario Agostino Gemelli,Rome, Italy

Marshall J.C.Department of Surgery, and Interdepartmental Division of Critical Care,General Hospital and University of Toronto, Toronto, Canada

Marshall K.A.M.Department of Surgery, and Interdepartmental Division of Critical Care,General Hospital and University of Toronto, Toronto, Canada

Martínez-Pellús A.Intensive Care Unit,Hospital Universitario Virgen de la Arrixaca,Murcia,Spain

XVContributors

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Mino G.Department of Bacteriology, University Hospital, Guayaquil, Ecuador

Nardi G.Department of Anesthesia and Intensive Care, University Hospital of S. CamilloForlanini, Rome, Italy

Novelli A.Department of Pharmacology, Florence University, Florence, Italy

Nunn A.J.Department of Pharmacy, Alder Hey Children’s Hospital, Liverpool , UK

Palomar M.Intensive Care Unit, Hospital Universitario Vall d’Hebrón,Barcelona, Spain

Pastor-Benavent J.Intensive Care Unit, Juan Canalejo Hospital, Coruña, Spain

Petros A.J.Pediatric Intensive Care Unit, Great Ormond Street Children’s Hospital, NHSTrust, London, UK

Pigna A.Neonatal Intensive Care Unit, San Orsola Hospital, Bologna, Italy

Pizer B.P.Department of Oncology, Alder Hey Children’s Hospital, NHS Trust,Liverpool, UK

Pollock K.Department of Pharmacy, Western Infirmary, Glasgow, UK

Randino A.Department of Perioperative Medicine, Intensive Care and Emergency,University of Trieste, Cattinara Hospital, Trieste, Ital

Rascado-Sedes P.Intensive Care Unit, Juan Canalejo Hospital, Coruña, Spain

Reilly N.J.Department of Pharmacy, Alder Hey Children’s Hospital,Liverpool, UK

XVI Contributors

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Rinaldi S.Department of Anesthesia and Critical Care, Florence University, Florence, Italy

Rios G.Department of Pediatric Intensive Care, Gustavo Fricke Children’s Hospital,Vina del Mar, Chile

Rogers T.Department of Clinical Microbiology, Trinity Centre, Dublin, Ireland

Rommes J.H.Department of Intensive Care, Gelre Ziekenhuizen, Apeldoorn, The Netherlands

Rosseneu S.Department of Pediatric Gastroenterology, Barts and the London NHS Trust,London, UK

Sanchez M.Department of Intensive Care, University Hospital of Principe de Asturias,Madrid, Spain

Sarginson R.E.Department of Anaesthesia and Intensive Care, Alder Hey Children’s Hospital,NHS Trust, Liverpool, UK

Schelenz S.Department of Infection, Guy’s and St. Thomas’ Hospital Trust and Departmentof Infectious Disease, GKT School of Medicine, St. Thomas’ Hospital,London, UK

Selby A.Department of Anaesthesia and Intensive Care, Alder Hey Children’s HospitalNHS Trust, Liverpool, UK

Sganga G.Surgery and Transplantation Unit, Policlinico Universitario Agostino Gemelli,Rome, Italy

Silvestri L.Emergency Department and Unit of Anesthesia and Intensive Care, PresidioOspedaliero of Gorizia, Gorizia, Italy

Spronk P.E.Department of Intensive Care, Gelre Ziekenhuizen, Apeldoorn, The Netherlands

XVIIContributors

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Taylor N.Department of Medical Microbiology, University of Liverpool, Liverpool, UK

Thorburn K.Department of Pediatric Intensive Care, Alder Hey Children’s Hospital, ,Liverpool, UK

Tomasini A.yDepartment of Perioperative Medicine, Intensive Care and Emergency, University

of Trieste, Cattinara Hospital, Trieste, Italy

Tong C.Y.W.Department of Infection, Guy’s and St. Thomas’ Hospital Trust and Departmentof Infectious Disease, GKT School of Medicine, St. Thomas’ Hospital,London, UK

Torres A.Institut Clínic de Pneumologia i Cirurgia Toràcica, Hospital Clínic,Universitat de Barcelona, Spain

Vallés J.Intensive Care Department, Hospital Sabadell, Sabadell, Spain

van der Spoel J.I.Department of Intensive Care, OLV Gasthuis, Amsterdam, The Netherlands

van der Voort P.H.J.Department of Intensive Care, Medical Center Leeuwarden,Leeuwarden, The Netherlands

van Saene H.K.F.Department of Medical Microbiology, University of Liverpool, Alder HeyChildren’s Hospital, NHS Trust, Liverpool, UK

van Saene J.J.M.Department of Pharmaceutical Technology, University of Groningen,Groningen, The Netherlands

Viviani M.yDepartment of Perioperative Medicine, Intensive Care and Emergency, University

of Trieste, Cattinara Hospital, Trieste, Italy

Zandstra D.F.Department of Intensive Care, Onze Lieve Vrouwe Gasthuis Hospital,Amsterdam, The Netherlands

XVIII Contributors

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ABELLA A., 49ALCOCK S.R., 171ALCÓN A., 315ALÍA I., 429ALVAREZ-ROCHA L., 495BAINES P.B., 593BARCENILLA-GAITE F., 495BERLOT G., 537BRISINDA G., 379CASTAGNETO G., 379CERDÀ E., 49, 191, 429COOKE F.J., 155CORBELLA X., 247DAMJANOVIC V., 247, 415DE GAUDIO A.R., 91, 213DE LA CAL M.A., 3, 49, 191, 429DE SILVESTRE A., 231DI FILIPPO A., 213FÀBREGAS N., 315FARIASFF J., 415FERNÀNDEZ-VILADRICH P.F., 337FERRER R., 337FONTANA F., 73GARCIA-HIERRO P., 49, 73GULLO A., 297HUGHES J., 191ISCRA F., 549IZQUIERDO G., 73KERR S., 297LOWRY K.G., 621MARIA G., 379MARSHALL J.C., 605, 621MARSHALL K.A.M., 605MARTÍNEZ-PELLÚS A., 455MINO G., 37NARDI G., 231NOVELLI A., 91

Authors’ Index

Vol.Infection Romane 1-02-2005 17:06 Pagina XIXginagina

NUNN A.J., 575PALOMARPP M., 455PASTORPP -BENAVENT J., 495PETROS A.J., 415, 621PIGNA A., 415PIZER B.P., 171POLLOCK K., 575RANDINO A., 549RASCADO-SEDES P., 495REILLY N.J., 231, 575, 593RINALDI S., 91RIOS G., 15ROGERS T., 155ROMMES J.H., 515ROSSENEU S., 15SANCHEZ M., 171SARGINSON R.E., 3SCHELENZ S., 469SELBY A., 515SGANGA G., 379SILVESTRI L., 37, 61, 297SPRONK P.E., 15TAYLORTT N., 3, 191, 593THORBURN K., 565TOMASINI A., 537TONG C.Y.W., 469TORRES A., 315VALLÉSVV J., 337VAN DER SPOEL J.I., 247VAN DER VOORT P.H.J., 565VAN SAENE H.K.F., 3, 37, 61, 73, 231, 247, 429, 565, 593, 621VAN SAENE J.J.M., 15VIVIANI M., 61, 537ZANDSTRA D.F., 515, 565

XX Authors Index

Vol.Infection Romane 1-02-2005 17:06 Pagina XXginagina