Empirical antimicrobial therapy of septic shock patients: Adequacy and impact on the outcome*

Abstract

The prescription of empirical antimicrobial therapy by a senior physician in agreement with practice guidelines made it possible to achieve a crude rate of 89% of adequate antimicrobial therapy in study patients. Inadequate antimicrobial therapy was associated with a 39% excess of mortality. A de-escalation of the empirical therapy was possible in 64% of patients.

De-escalation in severe sepsis: still an important part of our armamentarium against antimicrobial resistance, of course!

“…In agreement with observational studies [3], our trial in patients with severe sepsis showed that de-escalation did not affect mortality. In contrast, de-escalation was associated with an increased use of antimicrobials.…”

Rapid detection of non-enterobacteriaceae directly from positive blood culture using fluorescent <i>In situ </i>hybridization

“…This in turn could reduce the overall mortality among patients with gram negative bacteraemia as has been documented in previous studies. 10 FISH has proven to be a powerful molecular method for identiÞ cation, visualization and quantiÞ cation of organisms of interest in microbial communities. 11 Several reports show that FISH has already been successfully applied for the detection of E. coli, H. pylori, Staphylococcus aureus and Brucella spp.…”

Diretrizes para tratamento da sepse grave/choque séptico: abordagem do agente infeccioso - diagnóstico

“…Additionally, tailoring antibiotic therapy to the organism sensitivity data results in lower mortality (B) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)21,22,(24)(25)(26) (D). (17)(18)(19)(20) Some studies have shown that running blood cultures in patients without risk factors hospitalized for community-acquired pneumonia may not be costeffective given the low rate of positive results (B) (31) (C) (32) .…”

“…The earlier appropriate therapy is started, the better the patient's prognosis will be (B). (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) Appropriate antibiotic therapy allows for deescalation from empirical therapy to a more specific antibiotic regimen, which is suitable for organism sensitivity and may prevent the risk of selecting resistant bacteria (D). (17)(18)(19)(20) Antibiotic de-escalation to more specific and less numerous antibiotic regimens reduces the overall cost of therapy (B).…”