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Published on: August 30, 2018
Gram-positive cocci infections in intensive care: guide to antibacterial selection
Francisco Alvarez-Lerma1, Santiago Grau, Maria-Pilar Gracia-Arnillas
1Intensive Care Medicine Service, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Abstract:
The incidence of multiresistance in Gram-positive cocci causing infections in critically ill patients admitted to the intensive care unit (ICU) has increased notably in recent years. Thus, therapeutic proposals have been modified according to the emergence of multiresistant cocci and adapted to epidemiological markers of individual infectious processes, geographical variations of these markers, the availability of new antibacterials, and advances in the knowledge of pharmacokinetic and pharmacodynamic aspects of their use. The current management of critically ill patients should consider new therapeutic approaches, such as the "de-escalating strategy", which includes the administration of empirical antibacterials active against multiresistant pathogens followed by directed treatment based on unequivocal data from antibacterial-susceptibility testing. Optimisation of antibacterial treatment should be viewed in the context of the need to determine plasma drug concentrations, pharmacoeconomic considerations and control of drug-related adverse events. Therapeutic proposals should be developed within the framework of the antibacterial policy of each hospital. The present review is focused on the description of the therapeutic strategies for the main infectious processes caused by Gram-positive cocci in severely ill patients admitted to the ICU according to a review of the pertinent literature and the clinical experience of the authors.
Insights
Multiresistant Gram-positive cocci infections in intensive care units (ICUs) require updated treatment strategies. A de-escalating approach, guided by susceptibility testing, optimizes antibacterial therapy for critically ill patients.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Rising incidence of multiresistance in Gram-positive cocci infections within intensive care units (ICUs).
- Need for adaptive therapeutic strategies considering evolving resistance patterns, geographical variations, and new antibacterials.
- Importance of pharmacokinetic and pharmacodynamic considerations in treating severe infections.
Purpose of the Study:
- To review and describe therapeutic strategies for Gram-positive cocci infections in critically ill ICU patients.
- To highlight the role of de-escalating strategies in managing multiresistant pathogens.
- To emphasize optimizing antibacterial treatment based on susceptibility data and clinical context.
Main Methods:
- Comprehensive review of pertinent literature on Gram-positive cocci infections in ICUs.
- Analysis of clinical experience from authors regarding therapeutic approaches.
- Focus on evidence-based strategies for managing multiresistant infections.
Main Results:
- Multiresistant Gram-positive cocci pose a significant challenge in ICUs, necessitating revised treatment protocols.
- The de-escalating strategy, combining empirical broad-spectrum therapy with targeted treatment, is a key approach.
- Optimizing therapy involves considering drug concentrations, cost-effectiveness, and adverse events.
Conclusions:
- Effective management of Gram-positive cocci infections in critically ill patients hinges on tailored, evidence-based therapeutic strategies.
- Hospital-specific antibacterial policies are crucial for guiding treatment decisions.
- Continuous adaptation to emerging resistance and new therapeutic options is essential for improving patient outcomes.
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