Gram-Positive Cocci Infections in Intensive Care

Abstract

The incidence of multiresistance in Gram-positive cocci causing infections in critically ill patients admitted to the intensive care unit (ICU) has increased notably in recent years. Thus, therapeutic proposals have been modified according to the emergence of multiresistant cocci and adapted to epidemiological markers of individual infectious processes, geographical variations of these markers, the availability of new antibacterials, and advances in the knowledge of pharmacokinetic and pharmacodynamic aspects of their use. The current management of critically ill patients should consider new therapeutic approaches, such as the "de-escalating strategy", which includes the administration of empirical antibacterials active against multiresistant pathogens followed by directed treatment based on unequivocal data from antibacterial-susceptibility testing. Optimisation of antibacterial treatment should be viewed in the context of the need to determine plasma drug concentrations, pharmacoeconomic considerations and control of drug-related adverse events. Therapeutic proposals should be developed within the framework of the antibacterial policy of each hospital. The present review is focused on the description of the therapeutic strategies for the main infectious processes caused by Gram-positive cocci in severely ill patients admitted to the ICU according to a review of the pertinent literature and the clinical experience of the authors.

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

“…(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). (21)(22)(23)(24)(25)(26) …”

“…(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) . However, in most severe cases of bacteremia, severe sepsis or septic shock, blood cultures could help with the identification of the causative agent and may consequently guide antibiotic therapy; despite this, the blood culture-identified agent may not be the agent causing pneumonia, especially if the patient has other sites of infection in addition to the lung foci (B).…”

Antimicrobial‐Resistant Streptococcus pneumoniae in Canadian Hospitals: Results from the 2007 CANWARD Study

“…It disproportionately affects young, elderly and immunocompromised persons (3,4). Streptococcus pneumoniae is the most common bacterial pathogen, responsible for at least 15% of CAP cases; 20% of patients with pneumococcal CAP become bacteremic and require hospitalization (3,(5)(6)(7)(8). Fatality rates for pneumonia remain high, in the range of 15% to 36%, and are highest among bacteremic patients with pneumococcal pneumonia.…”

“…Fatality rates for pneumonia remain high, in the range of 15% to 36%, and are highest among bacteremic patients with pneumococcal pneumonia. S pneumoniae is also an important cause of meningitis, otitis media and bacteremia (3,(6)(7)(8).…”

Necrotizing pancreatitis and antibiotic prophylaxis. To use or not to use . . . that is the question

“…The use of prolonged antibiotic prophylaxis in acute necrotizing pancreatitis therefore seems at odds with our understanding of antibiotic prophylaxis. In addition, the growing resistance of organisms 9,10 to our antimicrobial armory should warn us to proceed with caution when prescribing these agents.…”