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Antibiotics in sepsis

Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Intensive Care Medicine (Impact Factor: 5.54). 02/2001; 27 Suppl 1(14):S33-48. DOI: 10.1007/PL00003796
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Available from: Pierre-Yves Bochud, Aug 06, 2015
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    • "They have to be used expeditiously along with other early interventions for sepsis. However, the use of antibiotics is known to trigger the release of bacterial cell wall components that contribute to the severe inflammation in the body that leads to sepsis [8]. First report: The spontaneous and penicillin-stimulated release of water-soluble, glycerol-labeled polymers was compared in Streptococcus sanguis. "
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    • "Rather, it duplicates coverage, which is often unnecessary , and may miss optimizing coverage against the most likely pathogens. It is essential to get it right from the start and cover optimally the most likely pathogens rather than all possible pathogens (Box 2) [47] [48] [49] [50] [51] [52] [53] [54] [55]. "
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    ABSTRACT: This article is a brief overview of empiric antibiotic selection for sepsis and septic shock. The article includes a differential diagnosis of the mimics of sepsis and stresses a strategy for avoiding problems associated with antibiotic resistance. Although early appropriate empiric therapy is the cornerstone of sepsis and septic shock therapy, nonantibiotic interventions are critical as well. In patients with septic shock, adequate and effective early volume replacement is essential. Early surgical intervention is critical in controlling and eliminating the septic focus if sepsis is related to perforation of a viscus (eg, the colon); obstruction of the biliary, gastrointestinal, or urinary tract; or presence of an abscess that requires drainage. If device-related infection is the cause of sepsis, device removal is essential. Empiric monotherapy for sepsis and septic shock is preferred. Multiple-drug therapy is more expensive, has an increased potential for drug-drug interactions, has a higher likelihood of side effects, and does not decrease the resistance potential of the antibiotics being used. For these reasons, early empiric monotherapy is optimal and de-escalation is not necessary if initial mono therapy was wisely selected.
    Critical Care Clinics 05/2008; 24(2):313-34, ix. DOI:10.1016/j.ccc.2007.12.015 · 2.50 Impact Factor
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    • "As culture results are not available within the timeframe of ED care, anticipated pathogens must be predicted based on the infection site and past studies of the associated etiologies. Most studies describing the bacteriology and sites of infection in severe sepsis/septic shock include a combination of community-and hospital-acquired infections [77] [78] [79] [80] [81] [82] [83] [84] [85] [86] [87] [88] [89] [90] [91] [92] [93]. The common sites of infection are lung (35%), abdomen (21%), urinary tract (13%), skin and soft tissue (7%), other site (8%), and unknown primary site (16%) (compiled from 16 studies between 1963 and 1998 that included 8667 patients). "
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    ABSTRACT: Increased attention has focused recently on the acute management of severe sepsis and septic shock, conditions that represent the end-stage systemic deterioration of overwhelming infection. Clinical trials have identified new therapies and management approaches that, when applied early, appear to reduce mortality. Practice guidelines have been advanced by critical care societies, and many of the proposed interventions involve therapies other than antimicrobials directed at hemodynamic resuscitation or addressing adverse effects of the inflammatory cascade. Although many emergency departments (EDs) are now adopting treatment protocols for sepsis that are based on published treatment guidelines, recent research calls many of the initial recommendations into question, and validation trials of some of these approaches are ongoing. This article reviews the initial evaluation and treatment considerations of sepsis in the ED setting.
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