Therapy of sepsis

Area of Science:

• Infectious Diseases
• Clinical Pharmacology
• Critical Care Medicine

Background:

• The terms sepsis, infection, and bacteremia are often used interchangeably, leading to definitional ambiguity.
• Systemic Inflammatory Response Syndrome (SIRS) criteria have been proposed for clinical trial entry and therapeutic guidance.
• Empiric antibiotic therapy is standard for febrile hospitalized patients due to delayed culture results.

Purpose of the Study:

• To review current approaches to empiric antibiotic therapy for suspected bacterial infections in hospitalized patients.
• To discuss the role of clinical assessment and guidelines in guiding initial antimicrobial selection.
• To highlight key antimicrobial agents and factors influencing their choice.

Main Methods:

• Review of existing literature and clinical guidelines on sepsis and antibiotic therapy.
• Analysis of criteria used for initiating empiric antibiotic treatment.
• Discussion of the characteristics of broad-spectrum antimicrobial agents.

Main Results:

• Empiric antibiotic therapy is a cornerstone in managing febrile hospitalized patients with suspected infections.
• Clinical history and physical examination are critical for guiding empiric treatment decisions.
• Broad-spectrum monotherapy with agents like cefepime, ceftazidime, imipenem/cilastatin, and meropenem is often employed.

Conclusions:

• Established guidelines for empiric management of serious infections, initially for immunocompromised hosts, are applicable to general hospitalized patients.
• Selection of empiric antibacterial therapy for hospital-acquired infections should consider local epidemiologic patterns.
• No single antimicrobial agent is universally superior; tailored selection based on clinical factors and local resistance patterns is essential.