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.Methods
- 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%]).