Serious Infections in the Intensive Care Unit: diagnosis and management

To optimize the diagnostic accuracy of serious infections in the critically ill patient suspected of having infection. And to optimize certain antifungal treatment strategies in critically ill patients with invasive candidiasis.The main content of this thesis is divided into two sections. In section I we studied the predictive values of different biomarkers for serious infections i.e. bloodstream infections. The first goal was to find a biomarker that could discriminate between non-infectious causes of inflammation and microbial infection. The second goal was to determine if one of those biomarkers could predict the invasiveness (bacteraemia) and severity (septic shock, mortality) of microbial infection. The third goal was to determine optimal cut-off values for the prediction of microbial infection. In the section II we describe the safety and efficacy of different antifungal treatment strategies in critically ill patients. The goal was to evaluate the safety and efficacy of currently used antifungal agents and strategies. The second goal was, when possible, to give recommendations for possible changes in the current antifungal treatment strategies. These two sections are followed by a commentary that summarizes and discusses the main findings