. 2009 May 15:1003–1069. doi: 10.1016/B978-032304841-5.50053-4

Table 51-3.

Profile of Nosocomial Infection in the ICU

Infection	Major Pathogen	Risk Factors
Urinary tract	Pseudomonas aeruginosa	Urinary catheter
	Klebsiella and Enterobacter spp.	Monitoring of urine output
	Enterococci	Other urologic manipulation or bladder irrigations
	Staphylococcus epidermidis	Renal transplantation
	Candida spp.	Diabetes

	Female >male

Pneumonia	P. aeruginosa	Tracheostomy
	Klebsiella and Enterobacter spp.	Endotracheal tube, reintubation
	Serratia marcescens	Nasogastric tube
	Acinetobacter spp.	Intracranial pressure monitoring
	Staphylococcus aureus	Stress ulcer prophylaxis with H₂ blocker or antacids
	Oral anaerobes	Immunosuppression
	Immunosuppression	Granulocytopenia

Postsurgical wound	Staphylococcus aureus	Trauma, especially penetrating abdominal injury
	Escherichia coli and other gramnegative bacilli	Gastrointestinal or radical gynecologic surgery
	Enterococci	Prolonged operation
	Bacteroides fragilis and other bowel anaerobes	Immunosuppressive therapy
		Granulocytopenia
		Hepatic transplantation
		Central venous catheter in place >5 days
Bacteremia from intravascular devices Catheter related	Coagulase-negative staphylococci	Heavy colonization of insertion site skin
	S. aureus	Femoral vein insertions
	Candida spp.	Catheter guidewire exchanges

Contaminated infusate	Enterobacter spp.
	S. marcescens
	Citrobacter spp.
	Pseudomonas cepacia or Xanthomonas maltophilia

Antibiotic-associated diarrhea or colitis	Clostridium difficile	Prolonged antibiotic therapy, especially with clindamycin or broad-spectrum β-lactams
Antibiotic-associated diarrhea or colitis		Enteral tube feeding

Candidemia	Candida spp.	Broad-spectrum, prolonged antimicrobial therapy
		Mucosal or urinary colonization
		Central venous catheter
		Hyperalimentation
		Renal failure

Modified from Maki DG: Nosocomial infection. In Parrillo JE (ed): Current Therapy in Critical Care Medicine, 2nd ed. Philadelphia, BC Decker, 1991.