Initial antimicrobial management of sepsis

Abstract

Sepsis is a common consequence of infection, associated with a mortality rate > 25%. Although community-acquired sepsis is more common, hospital-acquired infection is more lethal. The most common site of infection is the lung, followed by abdominal infection, catheter-associated blood steam infection and urinary tract infection. Gram-negative sepsis is more common than gram-positive infection, but sepsis can also be due to fungal and viral pathogens. To reduce mortality, it is necessary to give immediate, empiric, broad-spectrum therapy to those with severe sepsis and/or shock, but this approach can drive antimicrobial overuse and resistance and should be accompanied by a commitment to de-escalation and antimicrobial stewardship. Biomarkers such a procalcitonin can provide decision support for antibiotic use, and may identify patients with a low likelihood of infection, and in some settings, can guide duration of antibiotic therapy. Sepsis can involve drug-resistant pathogens, and this often necessitates consideration of newer antimicrobial agents.

Clinical Application and Influencing Factor Analysis of Metagenomic Next-Generation Sequencing (mNGS) in ICU Patients With Sepsis

“…Severe sepsis requires that the infection site, microbial species, and empirical anti-infection treatment are identified first ( Rhodes et al., 2017 ; Cecconi et al., 2018 ; Niederman et al., 2021 ). In sepsis management strategies, early recognition and standardized management such as fluid resuscitation and hormone use are proposed, but active antibiotic use remains the cornerstone of successful sepsis treatment ( Rhodes et al., 2017 ; Cendejas-Bueno et al., 2019 ; Niederman et al., 2021 ). Pathogen identification and beginning or adjusting the antibiotic therapy as soon as possible are essential.…”

A new indicator: The diagnostic value of CD8+T/B lymphocyte ratio in sepsis progression

“… 1 Meanwhile, it is the main cause of death among Intensive Care Unit (ICU) patients. 2 Its mechanism is related to immune dysfunction, infection, and secretion of inflammatory factors. The imbalance of the homeostasis of pro-inflammatory and anti-pro-inflammatory responses plays an important role in this process.…”

A cytokine/PTX3 prognostic index as a predictor of mortality in sepsis

“…Despite the recent revision of the definition of sepsis, diagnosis is still challenging for clinicians, in particular in the identification of patients at early stages ( 5 ). Alongside the diagnostic question, also important is the need to have early prognostic indications allowing clinicians to activate the most appropriate therapies based on the mortality risk of each individual patient ( 2 , 6 – 10 ). A recent review collected 5367 studies identifying 258 different biomarkers of sepsis with potential diagnostic and/or prognostic functions ( 11 ).…”