NYMC Faculty Publications

Fever and Infections in Surgical Intensive Care: An American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Eden Nohra, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Rachel D. Appelbaum, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Michael Steven Farrell, Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
Thomas Carver, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Hee Soo Jung, Department of Surgery, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
Jordan Michael Kirsch, Department of Surgery, Westchester Medical Center/ New York Medical College, Valhalla, NY, USA.
Lisa M. Kodadek, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Samuel Mandell, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Aussama Khalaf Nassar, Department of Surgery, Section of Acute Care Surgery, Stanford University, Stanford, California, USA.
Abhijit Pathak, Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
Jasmeet Paul, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
Bryce Robinson, Department of Surgery, Harborview Medical Center, Seattle, Washington, USA.
Joseph Cuschieri, Department of Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
Deborah M. Stein, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland, USA.

Author Type(s)

Faculty

DOI

10.1136/tsaco-2023-001303

Journal Title

Trauma Surgery & Acute Care Open

First Page

e001303

Document Type

Article

Publication Date

1-1-2024

Department

Surgery

Abstract

The evaluation and workup of fever and the use of antibiotics to treat infections is part of daily practice in the surgical intensive care unit (ICU). Fever can be infectious or non-infectious; it is important to distinguish between the two entities wherever possible. The evidence is growing for shortening the duration of antibiotic treatment of common infections. The purpose of this clinical consensus document, created by the American Association for the Surgery of Trauma Critical Care Committee, is to synthesize the available evidence, and to provide practical recommendations. We discuss the evaluation of fever, the indications to obtain cultures including urine, blood, and respiratory specimens for diagnosis of infections, the use of procalcitonin, and the decision to initiate empiric antibiotics. We then describe the treatment of common infections, specifically ventilator-associated pneumonia, catheter-associated urinary infection, catheter-related bloodstream infection, bacteremia, surgical site infection, intra-abdominal infection, ventriculitis, and necrotizing soft tissue infection.

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