Critical Care Medicine-Infections and Immunologic Disease>>>>>Systemic Infections
Question 2#

Which of the following statements are TRUE about empiric antibiotic selection for patients in septic shock?

A. Selection should account for recently received antibiotics, prior organisms, and susceptibility patterns for each patient, and local antimicrobial resistance patterns
B. The broadest-spectrum antibiotic combination available should be used until microbiologic testing results return
C. Two antipseudomonal antibiotics of the same class should be used when there is concern for Pseudomonas aeruginosa bacteremia
D. A and C

Correct Answer is A

Comment:

Correct Answer: A

Empiric antibiotic selection for sepsis and septic shock should be tailored to the individual. Clinicians should take into account each patient’s medical history and comorbidities, immune deficits, prior microbiologic history including known antimicrobial-resistant infections, recent hospitalization or facility contact, suspected site of infection, presence of invasive or indwelling devices, and local infection prevalence and antimicrobial resistance patterns. Most patients with septic shock should receive at least two antibiotics from two different classes (combination therapy), especially if a gram-negative pathogen is suspected. If severe P. aeruginosa infection is suspected, one or two antibiotics can be used empirically, but if two antibiotics are used, they should be from different classes. The broadest-spectrum antibiotic combination available is not always appropriate, as broad-spectrum antimicrobial use has the potential to drive antimicrobial resistance, confer additional toxicities, and may not benefit the patient.

References:

1. De Waele JJ, Akova M, Antonelli M, et al. Antimicrobial resistance and antibiotic stewardship programs in the ICU: insistence and persistence in the fight against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance. Intensive Care Med. 2018;44:189-196.
2. Johnson MT, Reichley R, Hoppe-Bauer J, Dunne WM, Micek S, Kollef M. Impact of previous antibiotic therapy on outcome of Gram-negative severe sepsis. Crit Care Med. 2011;39:1859-1865.