Sepsis and Septic Shock: Selection of Empiric Antimicrobial Therapy

2008 ◽  
Vol 24 (2) ◽  
pp. 313-334 ◽  
Author(s):  
Burke A. Cunha
Keyword(s):  
Septic Shock ◽  
Antimicrobial Therapy ◽  
Empiric Antimicrobial Therapy ◽  
Sepsis And Septic Shock ◽  
Selection Of

scholarly journals The importance of early detection of endotoxemia

2016 ◽  
Vol 22 (7) ◽  
pp. 503-509 ◽  
Author(s):  
Barbara Adamik ◽  
Jakub Smiechowicz ◽  
Andrzej Kübler
Keyword(s):  
Septic Shock ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Clinical Challenge ◽  
Endotoxin Activity ◽  
Sepsis And Septic Shock ◽  
Clinical Conditions ◽  
Endotoxin Elimination ◽  
Selection Of Patients ◽  
Selection Of

Endotoxin is considered a key signaling molecule in the pathogenesis of sepsis and septic shock. Anti-endotoxin therapies may result in the improvement of a patient’s clinical condition and lower mortality. The pressing clinical challenge is to identify patients for whom endotoxin elimination would be the most beneficial. An endotoxin activity assay (EAA) has been available for detection of endotoxins, allowing selection of patients at high risk of endotoxemia in intensive care units (ICUs). We studied a cohort of 172 consecutive patients who had septic shock on admission to the ICU. Endotoxin activity (EA) was measured with a rapid chemiluminescent EAA, regarded as point-of-care testing. Endotoxemia with a mean EA of 0.59 ± 0.14 EAU was present in 104 patients (60%) and absent in 68 patients (EA = 0.25 ± 0.11 EAU). The risk of endotoxemia increased with the presence of a Gram-negative infection [odds ratio (OR) 3.1, 95% confidence interval (CI) 1.6–5.9; P = 0.001] and bacteremia (OR 3.8, 95% CI 1.6–8.9; P = 0.02) but did not change with a diagnosis of peritonitis (OR 1.03, 95% CI 0.54–1.97; P = 0.90). These findings indicate that anti-endotoxin interventions should be tailored to individual patients based on both clinical conditions and measured endotoxin levels.

Septic Shock

1992 ◽  
Vol 7 (2) ◽  
pp. 90-100 ◽  
Author(s):  
Margaret M. Parker ◽  
Mitchell P. Fink
Keyword(s):  
Septic Shock ◽  
Supportive Care ◽  
Antimicrobial Therapy ◽  
Clinical Manifestations ◽  
Sepsis Syndrome ◽  
Adjunctive Treatment ◽  
Cardiovascular Changes ◽  
The Past ◽  
Sepsis And Septic Shock ◽  
Very High

The incidence of sepsis and septic shock has been increasing dramatically over the past 10 years. Despite advances in antimicrobial therapy, the mortality of septic shock remains very high. We review the clinical manifestations of sepsis and septic shock and describe the cardiovascular manifestations. Pathophysiology of the cardiovascular changes is discussed, and mediators believed to be involved in the pathogenesis are reviewed. Management of septic shock is also discussed, including antimicrobial therapy, supportive care, and adjunctive treatment aimed at affecting the mediators involved in producing the sepsis syndrome.

Impact of Pharmacist Intervention on Selection and Timing of Appropriate Antimicrobial Therapy in Septic Shock

2017 ◽  
Vol 31 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Melanie E. Laine ◽  
Jeremy D. Flynn ◽  
Alexander H. Flannery
Keyword(s):  
Septic Shock ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Empiric Therapy ◽  
Pharmacist Intervention ◽  
Entire Cohort ◽  
Sepsis Bundle ◽  
Selection Of ◽  
Antimicrobial Administration

Background: Current guidelines for septic shock management recommend administration of appropriate, broad-spectrum antimicrobials within 1 hour of recognition. Objective: To evaluate the interventions pharmacists make as part of a sepsis response team and to determine if these interventions increase the proportion of patients with appropriate empiric antimicrobial therapy. Methods: A retrospective cohort study was undertaken reviewing adult patients in a large, academic medical center with confirmed septic shock who had an order for a “sepsis bundle,” which includes notification of a pharmacist to assess adequacy of empiric therapy. Pharmacist interventions with regard to selection of empiric antimicrobials were documented. The proportion of patients with initial successful selection of antimicrobial therapy (SSAT) before and after pharmacist intervention was assessed as well as the time to first antimicrobial administration and time to appropriate antimicrobial administration. Results: A total of 76 patients were included. Pharmacist intervention increased the proportion of patients with SSAT from 66% to 80% ( P = .04). Median time to first antimicrobial administration was 43 minutes, and time to appropriate antimicrobial therapy was 1 hour, 34 minutes for the entire cohort, with pharmacist intervention decreasing the latter time significantly in patients without SSAT on initiation of the “sepsis bundle” ( P < .001). Conclusion: Pharmacist assessment of patients in septic shock offers the opportunity to improve SSAT. Systems designed to use a pharmacist responder for the care of patients with septic shock maximize the selection of antimicrobials, facilitate rapid administration, and improve surrogate outcomes for mortality in septic shock.

Antimicrobial therapy for patients with severe sepsis and septic shock: An evidence-based review

2004 ◽  
Vol 32 (Supplement) ◽  
pp. S495-S512 ◽  
Author(s):  
Pierre-Yves Bochud ◽  
Marc Bonten ◽  
Oscar Marchetti ◽  
Thierry Calandra
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Antimicrobial Therapy ◽  
Evidence Based ◽  
Sepsis And Septic Shock

Impact of Hyperoncotic Albumin on Duration of Vasopressor Support inSeptic Shock: A PropensityScore–Matched Analysis

2020 ◽  
pp. 106002802096364
Author(s):  
Alexander H. Flannery ◽  
Gary D. Owen ◽  
Angel Coz ◽  
Melissa L. Thompson Bastin ◽  
Kripa Patel
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Large Trial ◽  
Matched Cohort ◽  
Albumin Administration ◽  
Sepsis And Septic Shock ◽  
Vasopressor Use ◽  
The Impact ◽  
Selection Of Patients ◽  
Selection Of

Background While albumin has not been shown to reduce mortality in sepsis and septic shock, a tertiary analysis of a large trial suggested that it may reduce the duration of vasopressor use in septic shock. Objective We sought to test if 25% albumin administration was associated with reduced cumulative vasopressor use in septic shock in a real-world setting. Methods This was a retrospective, propensity score–matched cohort study of septic shock in which patients receiving albumin were compared with a matched cohort of those not receiving albumin. The primary outcome was days alive and free of vasopressors. Results The matched cohort included 335 patients who received albumin and 335 who did not. The days alive and free of vasopressors were similar between the albumin and no albumin groups: 17.4 (0-24.8) versus 19.4 (0-25.3); P = 0.160. Similarly, in-hospital mortality was no different between groups (46.9% vs 44.8%; P = 0.587). Receipt of albumin was associated with fewer ventilator-free and intensive care unit (ICU)-free days: 0 (0-19) versus 11 (0-23), P = 0.007, and 0 (0-18) versus 10.6 (0-22.1), P = 0.002, respectively. Conclusion and Relevance Albumin use in septic shock was not associated with additional days alive and free of vasopressors or in-hospital mortality. The finding of fewer ventilator- and ICU-free days may reflect selection of patients who were critically ill for longer periods of time before or after albumin administration. Additional study is needed to clarify the impact that timing may have on the effectiveness of albumin in septic shock.

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