Diagnosis and Management of Systemic Infections and Fever in Neurological Patients

 

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ABSTRACT

The hospital course of a patient with a neurological disorder may be complicated by the development of fever, urinary tract infection (UTI), bacteremia, pneumonia, diarrhea, pressure sores, or intravenous line infections. An approach to each of these is provided in this review as well as recommendations for empirical therapy of catheter-related UTIs, intravenous line infections, and aspiration pneumonia.

REFERENCES

• 1 Wolff S M. Biological effects of bacterial endotoxins in man.  J Infect Dis . 1973;  733-758 (733-758 )
  PubMedGoogle Scholar
• 2 Smith J W, Urba W j, Curti B D. The toxic and hematologic effects of interleukin-1 alpha administered in a phase I trial to patients with advanced malignancies.  J Clin Oncol . 1992;  10 1141-1152
  PubMedGoogle Scholar
• 3 Malcangi U, Moro M L, Carpi D, Ramello A. Urinary tract infection prevention in catheterized patients. Prevalence National Study: preliminary studies at the Pnerolo Hospital.  Minerva Urol Nefrol . 1996;  48 43-46
  PubMedGoogle Scholar
• 4 Sobel J D, Kaye D. Urinary tract infections. In: Mandell Gl, Douglas RG Jr, Bennett JE, eds. Principles and Practice of Infectious Diseases 3rd ed. New York: Churchill Livingstone 1990: 582-611
  Google Scholar
• 5 Nicolle L E, Mayhew W J, Bryan L. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women.  Am J Med . 1987;  83 27-33
  PubMedGoogle Scholar
• 6 Beaujean D J, Blok H E, Vandenbroucke-Grauls C M, Weersink A J, Raymakers J A, Verhoef J. Surveillance of nosocomial infections in geriatric patients.  J Hosp Infect . 1997;  36 275-284
  CrossrefPubMedGoogle Scholar
• 7 Padoveze M C, Dantas S P, Reginato L, von Nowakonski A, deOliveira U M, Trabasso P. Relative frequency of nosocomial microorganisms at UNICAMP University Hospital from 1987 to 1994.  Rev Inst Med Trop Sao Paulo . 1997;  39 333-336
  PubMedGoogle Scholar
• 8 Bregenzer T, Conen D, Sakmann P, Widmer A F. Is routine replacement of peripheral intravenous catheters necessary?.  Arch Intern Med . 1998;  158 151-156
  CrossrefPubMedGoogle Scholar
• 9 Cunha B A. Intravenous line infections.  Crit Care Clin . 1998;  2 339-346
  PubMedGoogle Scholar
• 10 Richards M J, Edwards J R, Culver D H, Gaynes R P. Nosocomial infections in medical intensive care units in the United States: National Nosocomial Infections Surveillance System.  Crit Care Med . 1999;  27 887-892
  CrossrefPubMedGoogle Scholar
• 11 Weinstein M P, Towns M L, Quartey S M. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults.  Clin Infect Dis . 1997;  24 584-602
  PubMedGoogle Scholar
• 12 Ujiie H, Teshima H, Maeda T. Background and prognostic factors of fungemia in patients with hematological disease.  J Jpn Assoc Infect Dis . 1998;  72 912-917
  PubMedGoogle Scholar
• 13 Leroy O, Bosquet C, Vandenbussche C. Community acquired pneumonia in the intensive care unit: epidemiological and prognosis data in older people.  J Am Geriatr Soc . 1999;  47 539-556
  PubMedGoogle Scholar
• 14 Gopalakrishnan R, Hawley H B, Czachor J S, Markert R J, Bernstein J M. Stenotrophomonas maltophilia infection and colonization in the intensive care units of two community hospitals: a study of 143 patients.  Heart Lung . 1999;  28 134-141
  CrossrefPubMedGoogle Scholar
• 15 Ewig S, Torres A, El-Ebiary M. Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury: incidence, risk factors, and association with ventilator-associated pneumonia.  Am J Respir Crit Care Med . 1999;  159 188-198
  CrossrefPubMedGoogle Scholar
• 16 Campbell W, Hendrix E, Schwalbe R, Fattom A, Edelman R. Head-injured patients who are nasal carriers of Staphylococcus aureus are at high risk for Staphylococcus aureus pneumonia.  Crit Care Med . 1999;  27 798-801
  PubMedGoogle Scholar
• 17 Sanchez Garcia M, Cambronero Galache J A, Lopez Diaz J. Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients: a randomized, double-blind, placebo-controlled, multicenter trial.  Am J Respir Crit Care Med . 1998;  158 908-1016
  PubMedGoogle Scholar
• 18 Woeltje K F, Fraser V J. Preventing nosocomial infections in the intensive care unit: lessons learned from outcomes research.  New Horiz . 1998;  6(1) 84-90
  PubMedGoogle Scholar
• 19 Kertesz D, Chow A W. Infected pressure and diabetic ulcers.  Clin Geriatr Med . 1992;  8 835-852
  PubMedGoogle Scholar
• 20 Bryan C S, Dew C E, Reynolds K L. Bacteremia associated with decubitus ulcers.  Arch Intern Med . 1983;  143 2093
  CrossrefPubMedGoogle Scholar
• 21 Gellert G A, Waterman S H, Ewert D. An outbreak of acute gastroenteritis caused by a small round structured virus in a geriatric convalescent facility.  Infect Control Hosp Epidemiol . 1990;  11 459-464
  PubMedGoogle Scholar