Empiric Antibiotic Therapy for Severe Sepsis and Septic Shock

2016 ◽  
Vol 17 (2) ◽  
pp. 210-216 ◽  
Author(s):  
Taku Oshima ◽  
Yoshiyuki Kodama ◽  
Waka Takahashi ◽  
Yosuke Hayashi ◽  
Shinya Iwase ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Antibiotic Therapy ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic ◽  
Sepsis And Septic Shock

scholarly journals Discontinuation of Glycopeptides in Patients with Culture Negative Severe Sepsis or Septic Shock: A Propensity-Matched Retrospective Cohort Study

Antibiotics ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. 250
Author(s):  
Yong Chan Kim ◽  
Jung Ho Kim ◽  
Jin Young Ahn ◽  
Su Jin Jeong ◽  
Nam Su Ku ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Cohort Study ◽  
Antibiotic Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Culture Negative

Implementation of antibiotic stewardship is difficult in patients with sepsis because of severity of disease. We evaluated the impact of glycopeptide discontinuation (GD) in patients with culture negative severe sepsis or septic shock who received glycopeptides as initial empiric antibiotic therapy at admission. We conducted a single center retrospective cohort study between January 2010 and March 2018. GD was defined as discontinuation of initial empiric glycopeptides on availability of culture results, revealing the absence of identified pathogens. In 92 included patients, the leading causes of sepsis were pneumonia (34.8%) and intra-abdominal infection (23.9%); 28-day mortality and overall mortality were 14% and 21%, respectively. Glycopeptides were discontinued in 42/92 patients. After propensity score matching, baseline characteristics were not significantly different between the GD and non-GD (GND) groups. GND was associated with development of acute kidney injury (OR 5.54, 95% CI 1.49–20.6, P = 0.011). GD did not increase the 7-day, 14-day, and 28-day mortality compared with GND. The length of hospital stay was shorter in the GD group than in GND group (16.33 ± 17.11 vs. 25.05 ± 14.37, P = 0.082), though not statistically significant. GD may be safe and reduce adverse events of prolonged antibiotic use in patients with culture negative severe sepsis or septic shock receiving glycopeptides as initial empiric antibiotic therapy.

Empiric Antibiotic Treatment Reduces Mortality in Severe Sepsis and Septic Shock From the First Hour

2014 ◽  
Vol 42 (8) ◽  
pp. 1749-1755 ◽  
Author(s):  
Ricard Ferrer ◽  
Ignacio Martin-Loeches ◽  
Gary Phillips ◽  
Tiffany M. Osborn ◽  
Sean Townsend ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Antibiotic Treatment ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Sepsis And Septic Shock

scholarly journals Procalcitonin-guided algorithm to reduce length of antibiotic therapy in patients with severe sepsis and septic shock

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Andreas Hohn ◽  
Stefan Schroeder ◽  
Anna Gehrt ◽  
Kathrin Bernhardt ◽  
Berthold Bein ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Antibiotic Therapy ◽  
Sepsis And Septic Shock

Empiric Antibiotic Therapy for Staphylococcus aureus Septic Shock: Is Vancomycin Indicated?

2020 ◽  
Vol 48 (12) ◽  
pp. e1370-e1371 ◽  
Author(s):  
Ruben D. Villanueva ◽  
Joseph A. Iovine ◽  
Scott G. Blair ◽  
Ryan O. Kennedy ◽  
Jasmeet S. Paul
Keyword(s):  
Staphylococcus Aureus ◽  
Septic Shock ◽  
Antibiotic Therapy ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic

scholarly journals Adequate antibiotic therapy prior to ICU admission in patients with severe sepsis and septic shock reduces hospital mortality

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
José Garnacho-Montero ◽  
Antonio Gutiérrez-Pizarraya ◽  
Ana Escoresca-Ortega ◽  
Esperanza Fernández-Delgado ◽  
José María López-Sánchez
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Antibiotic Therapy ◽  
Icu Admission ◽  
Sepsis And Septic Shock

scholarly journals The Role of Adjunctive Therapies in Septic Shock by Gram Negative MDR/XDR Infections

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Stefano Busani ◽  
Erika Roat ◽  
Giulia Serafini ◽  
Elena Mantovani ◽  
Emanuela Biagioni ◽  
...  
Keyword(s):  
Septic Shock ◽  
Antibiotic Therapy ◽  
Multidrug Resistant ◽  
Blood Purification ◽  
Empiric Antibiotic Therapy ◽  
Alternative Strategies ◽  
Immune Paralysis ◽  
Empiric Antibiotic ◽  
The Relationship

Patients with septic shock by multidrug resistant microorganisms (MDR) are a specific sepsis population with a high mortality risk. The exposure to an initial inappropriate empiric antibiotic therapy has been considered responsible for the increased mortality, although other factors such as immune-paralysis seem to play a pivotal role. Therefore, beyond conventional early antibiotic therapy and fluid resuscitation, this population may benefit from the use of alternative strategies aimed at supporting the immune system. In this review we present an overview of the relationship between MDR infections and immune response and focus on the rationale and the clinical data available on the possible adjunctive immunotherapies, including blood purification techniques and different pharmacological approaches.

scholarly journals Population-Level Burden of Delayed or In Vitro Discordant Empiric Antibiotics Among Bacteremic Patients at US Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s44-s45
Author(s):  
Sameer Kadri ◽  
Yi Ling Lai ◽  
Sarah Warner ◽  
Jeffrey R. Strich ◽  
Ahmed Babiker ◽  
...  
Keyword(s):  
Septic Shock ◽  
Antibiotic Therapy ◽  
Population Level ◽  
Empiric Antibiotic Therapy ◽  
Teaching Hospitals ◽  
Antibiotic Resistant ◽  
Empiric Antibiotic ◽  
Resistance Patterns ◽  
To Receive

Background: Delayed or in vitro inactive empiric antibiotic therapy may be detrimental to survival in patients with bloodstream infections (BSIs). Understanding the landscape of delayed or discordant empiric antibiotic therapy (DDEAT) across different patient, pathogen, and hospital types, as well as by their baseline resistance milieu, may enable providers, antimicrobial stewardship programs, and policy makers to optimize empiric prescribing. Methods: Inpatients with clinically suspected serious infection (based on sampling of blood cultures and receiving systemic antibiotic therapy on the same or next day) found to have BSI were identified in the Cerner Healthfacts EHR database. Patients were considered to have received DDEAT when, on culture sampling day, they received either no antibiotic(s) or none that displayed in vitro activity against the pathogenic bloodstream isolate. Antibiotic-resistant phenotypes were defined by in vitro resistance to taxon-specific prototype antibiotics (eg, methicillin/oxacillin resistance in S. aureus) and were used to estimate baseline resistance prevalence encountered by the hospital. The probability of DDEAT was examined by bacterial taxon, by time of BSI onset, and by presence versus absence of antibiotic-resistance phenotypes, sepsis or septic shock, hospital type, and baseline resistance. Results: Of 26,036 assessable patients with a BSI at 131 US hospitals between 2005 and 2014, 14,658 (56%) had sepsis, 3,623 (14%) had septic shock, 5,084 (20%) had antibiotic-resistant phenotypes, and 8,593 (33%) received DDEAT. Also, 4,428 (52%) recipients of DDEAT received no antibiotics on culture sampling day, whereas the remaining 4,165 (48%) received in vitro discordant therapy. DDEAT occurred most often in S. maltophilia (87%) and E. faecium (80%) BSIs; however, 75% of DDEAT cases and 76% of deaths among recipients of DDEAT collectively occurred among patients with S. aureus and Enterobacteriales BSIs. For every 8 bacteremic patients presenting with septic shock, 1 patient did not receive any antibiotics on culture day (Fig. 1A). Patients with BSIs of hospital (vs community) onset were twice as likely to receive no antibiotics on culture day, whereas those with bloodstream pathogens displaying antibiotic-resistant (vs susceptible) phenotypes were 3 times as likely to receive in vitro discordant therapy (Fig. 1B). The median proportion of DDEAT ranged between 25% (14, 37%) in eight <300-bed teaching hospitals in the lowest baseline resistance quartile and 40% (31, 50%) at five ≥300-bed teaching hospitals in the third baseline resistance quartile (Fig. 2). Conclusions: Delayed or in vitro discordant empiric antibiotic therapy is common among patients with BSI in US hospitals regardless of hospital size, teaching status, or local resistance patterns. Prompt empiric antibiotic therapy in septic shock and hospital-onset BSI needs more support. Reliable detection of S. aureus and Enterobacteriales bloodstream pathogens and their resistance patterns earlier with rapid point-of-care diagnostics may mitigate the population-level impact of DDEAT in BSI.Funding: This study was funded in part by the National Institutes of Health Clinical Center, National Institutes of Allergy and Infectious Diseases, National Cancer Institute (NCI contract no. HHSN261200800001E) and the Agency for Healthcare Research and Quality.Disclosures: None

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