Initial antimicrobial management of sepsis

Critical Care

Lila Bouadma¹  Jan DeWaele²  Nick Daneman³  Marin H. Kollef⁴  Rebecca M. Baron⁵  Thierry Calandra⁶  Girish B. Nair⁷  Michael S. Niederman⁸  Jeffrey Lipman⁹ 

[1]AP-HP, Bichat Claude Bernard, Medical and Infectious Diseas ICU, University of Paris, Paris, France

[2]Department of Critical Care Medicine, Surgical Intensive Care Unit, Ghent University, Ghent, Belgium

[3]Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

[4]Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA

[5]Harvard Medical School

[6] Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, 02115, Boston, MA, USA

[7]Infectious Diseases Service, Department of Medicine, Lusanne University Hospital, University of Lusanne, Lusanne, Switzerland

[8]Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA

[9]Pulmonary and Critical Care Medicine, New York Presbyterian/Weill Cornell Medical Center, 425 East 61st St, 10065, New York, NY, USA

[10]Royal Brisbane and Women’s Hospital and Jamieson Trauma Institute, The University of Queensland, Brisbane, Australia

[11]Nimes University Hospital, University of Montpelier, Nimes, France

关键词: Sepsis;    Antibiotic therapy;    Antimicrobial therapy;    Fungal infection;    Pneumonia;    Intra-abdominal infection;    Pharmacokinetics;    Bacteremia;    Biomarkers;   

DOI  :  10.1186/s13054-021-03736-w

来源: Springer

【 摘 要 】

Sepsis is a common consequence of infection, associated with a mortality rate > 25%. Although community-acquired sepsis is more common, hospital-acquired infection is more lethal. The most common site of infection is the lung, followed by abdominal infection, catheter-associated blood steam infection and urinary tract infection. Gram-negative sepsis is more common than gram-positive infection, but sepsis can also be due to fungal and viral pathogens. To reduce mortality, it is necessary to give immediate, empiric, broad-spectrum therapy to those with severe sepsis and/or shock, but this approach can drive antimicrobial overuse and resistance and should be accompanied by a commitment to de-escalation and antimicrobial stewardship. Biomarkers such a procalcitonin can provide decision support for antibiotic use, and may identify patients with a low likelihood of infection, and in some settings, can guide duration of antibiotic therapy. Sepsis can involve drug-resistant pathogens, and this often necessitates consideration of newer antimicrobial agents.

【 授权许可】

CC BY