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[Antimicrobial chemotherapy of infection in intensive care conditions]
1Abteilung für Intensivmedizin, Universität Leipzig.
Abstract:
Antimicrobiologic chemotherapy is a cornerstone in the modern concept of treatment of sepsis. It is supported by a number of measures of intensive care. Externally acquired infections followed by sepsis mainly affect immunocompromised patients. They represent the minority. On the other hand, nosocomial infections play a dominant role in intensive care units. Nosocomial pneumonias and infections caused by intravascular plastics or endoprotheses are the most important reasons of sepsis. Initial antimicrobiologic therapy considers both the infectious focus and the specific epidemiology and resistance of microorganisms present in the department: it comprises the drawing of 2 to 3 blood cultures, taking of urinary cultures, tracheal secretion, liquor and wound-swaps for microbiologic examination. A gramstaining of the preparation can be helpful. In case the focus of the sepsis is not known, the first step of treatment consists of a combination of piperacilline or cephalosporins with aminoglycosides. If the septic state does not improve within 48 hours, a glycopeptide should be added against staphylococci (second step). If the combination fails, imipenem/cilastatin and aminoglycosides are administered as the third step. Normally, the result of cultures and resistogram already are available by this time. Today aminoglycosides are preferably given once daily, the serum level is monitored, and the toxicity of aminoglycosides is thus diminished.
Insights
Effective sepsis treatment relies on timely antimicrobial chemotherapy and intensive care. Initial treatment involves broad-spectrum antibiotics, with adjustments based on culture results and patient response to combat nosocomial infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Context:
- Sepsis management is critical in intensive care units (ICUs).
- Nosocomial infections, particularly pneumonia and those from medical devices, are primary causes of sepsis.
- Immunocompromised patients are susceptible to externally acquired infections leading to sepsis.
Purpose:
- To outline the principles of antimicrobial chemotherapy for sepsis treatment.
- To describe the stepwise approach to antibiotic selection based on clinical presentation and microbial resistance patterns.
- To emphasize the importance of microbiological diagnostics and monitoring in optimizing sepsis therapy.
Summary:
- Antimicrobial chemotherapy, alongside intensive care, is fundamental in sepsis treatment.
- Initial empirical therapy involves broad-spectrum antibiotics, guided by local epidemiology and resistance data, including blood, urine, and secretion cultures.
- Treatment escalates to include glycopeptides for staphylococcal coverage and imipenem/cilastatin if initial regimens fail, with aminoglycosides preferably administered once daily to minimize toxicity.
Impact:
- Optimized antimicrobial strategies can improve sepsis outcomes in ICUs.
- Understanding microbial resistance patterns is crucial for effective empirical treatment.
- Monitoring drug levels and adjusting therapy based on microbiological data enhances treatment efficacy and reduces adverse effects.