Antibiotic strategies in severe nosocomial sepsis

Critical Care Medicine, 05/03/2012

Heenen S et al. – Even in a highly focused environment with close collaboration among intensivists and infectious disease specialists, de–escalation may actually be possible in <50% of cases.


  • One hundred sixty-nine patients with 216 episodes of severe sepsis attributable to a hospital-acquired infection who required broad-spectrum β-lactam antibiotics alone or in association with other anti-infectious agents.


  • The major sources of infection were the lungs (44%) and abdomen (38%).
  • Microbiological data were available in 167 of the 216 episodes (77%).
  • Initial antimicrobial therapy was inappropriate in 27 episodes (16% of culture-positive episodes).
  • De-escalation was applied in 93 episodes (43%), escalation was applied in 22 episodes (10%), mixed changes were applied in 24 (11%) episodes, and there was no change in empirical antibiotic therapy in 77 (36%) episodes.
  • In these 77 episodes, the reasons given for maintaining the initial antimicrobial therapy included the sensitivity pattern of the causative organisms and previous antibiotic therapy.
  • The number of episodes when the chance to de-escalate may have been missed was small (4 episodes [5%]).

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