[Bacterial sepsis : Diagnostics and calculated antibiotic therapy]

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Clinical Pharmacology

Background:

• Sepsis and septic shock continue to have high mortality rates.
• Early effective antibiotic administration (within 1 hour) is a critical treatment goal.
• Pathophysiological changes in sepsis significantly impact antibiotic pharmacokinetics.

Purpose of the Study:

• To emphasize the need for structured treatment concepts in sepsis management.
• To advocate for individualized antibiotic dosing based on pharmacokinetic/pharmacodynamic (PK/PD) principles.
• To highlight the role of antibiotic stewardship and novel diagnostics/therapeutics.

Main Methods:

• Review of current sepsis treatment guidelines and challenges.
• Discussion of pharmacokinetic/pharmacodynamic (PK/PD) considerations in antibiotic selection and dosing.
• Evaluation of the utility of prolonged/continuous infusions, therapeutic drug monitoring (TDM), and antibiotic stewardship teams (ABS teams).
• Assessment of traditional culture-based diagnostics versus novel PCR-based methods.
• Consideration of novel antibiotics for multidrug-resistant (MDR) infections.

Main Results:

• Individualized antibiotic therapy, considering local resistance patterns and patient factors, is essential.
• Optimizing antibiotic delivery through prolonged infusions and TDM can improve PK/PD targets.
• Interdisciplinary collaboration within ABS teams enhances rational antibiotic use and patient outcomes.
• While PCR offers rapid pathogen identification, culture-based methods remain the gold standard for routine diagnostics.
• Novel antibiotics provide effective options for treating MDR infections.

Conclusions:

• Personalized, PK/PD-guided antibiotic strategies are crucial for improving sepsis outcomes.
• Antibiotic stewardship programs and advanced monitoring techniques are vital for managing complex infections.
• Continued research and integration of novel diagnostics and therapeutics are necessary to combat sepsis and antimicrobial resistance.