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A consensus statement on empiric therapy for suspected gram-positive infections in surgical patients
Joseph S Solomkin1, H Stephen Bjornson, Miguel Cainzos
1Division of Trauma and Critical Care, University of Cincinnati College of Medicine, Cincinnati, OH, USA. joseph.solomkin@uc.edu
Background:
Multidrug resistance among gram-positive pathogens in tertiary and other care centers is common. A systematic decision pathway to help select empiric antibiotic therapy for suspected gram-positive postsurgical infections is presented.
Data Sources:
A Medline search with regard to empiric antibiotic therapy was performed and assessed by the 15-member expert panel. Two separate panel meetings were convened and followed by a writing, editorial, and review process.
Conclusions:
The main goal of empiric treatment in postsurgical patients with suspected gram-positive infections is to improve clinical status. Empiric therapy should be initiated at the earliest sign of infection in all critically ill patients. The choice of therapy should flow from beta-lactams to vancomycin to parenteral linezolid or quinupristin-dalfopristin. In patients likely to be discharged, oral linezolid is an option. Antibiotic resistance is an important issue, and in developing treatment algorithms for reduction of resistance, the utility of these new antibiotics may be extended and reduce morbidity and mortality.
Insights
This study presents a decision pathway for empiric antibiotic therapy in postsurgical gram-positive infections, addressing rising multidrug resistance. The pathway guides clinicians from beta-lactams to newer agents to optimize patient outcomes.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Multidrug resistance in gram-positive pathogens is a significant challenge in healthcare settings.
- Postsurgical infections caused by gram-positive bacteria require effective empiric antibiotic strategies.
Framework:
- A systematic decision pathway was developed to guide empiric antibiotic selection.
- The pathway addresses the increasing prevalence of antibiotic resistance.
Implementation:
- An expert panel systematically reviewed Medline data on empiric antibiotic therapy.
- The development involved panel meetings, writing, editorial review, and a formal review process.
Implications:
- The primary goal of empiric treatment is to improve clinical status in postsurgical patients.
- Early initiation of empiric therapy is crucial for critically ill patients.
- Treatment selection should follow a stepwise approach, considering beta-lactams, vancomycin, and newer agents like linezolid and quinupristin-dalfopristin.
- Oral linezolid is an option for patients nearing discharge.
- Developing treatment algorithms can extend the utility of new antibiotics, reduce resistance, and improve patient morbidity and mortality.
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