Bacterial sepsis : Diagnostics and calculated antibiotic therapy.

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Clinical Pharmacy

Background:

• Sepsis and septic shock mortality remain high, emphasizing the need for timely and effective antibiotic interventions.
• Standard antibiotic dosing in sepsis is often inadequate due to pathophysiologic changes affecting drug pharmacokinetics (PK).
• Increasing prevalence of multidrug-resistant (MDR) pathogens necessitates optimized antimicrobial strategies.

Purpose of the Study:

• To highlight the importance of individualized antibiotic dosing based on PK/PD principles in sepsis management.
• To discuss the role of prolonged or continuous infusions and therapeutic drug monitoring (TDM) in achieving optimal antibiotic exposure.
• To emphasize the contribution of antibiotic stewardship teams (ABS) and novel diagnostics/therapeutics in combating sepsis and MDR infections.

Main Methods:

• Review of current literature and clinical practices in sepsis antibiotic management.
• Discussion of PK/PD principles and their application to antibiotic dosing in critically ill patients.
• Evaluation of diagnostic tools, including culture-based methods and emerging PCR technologies.
• Assessment of the role of novel antibiotics and interdisciplinary collaboration through ABS teams.

Main Results:

• Individualized PK/PD-guided dosing, particularly with prolonged or continuous infusions of beta-lactams (with TDM for continuous infusion), can improve antibiotic target attainment.
• Antibiotic stewardship programs involving multidisciplinary teams enhance rational antibiotic use and positively impact patient outcomes.
• While culture-based methods remain gold standard, PCR-based diagnostics offer adjunctive benefits in specific complex cases.
• Novel antibiotics provide crucial options for treating severe MDR infections, enabling targeted therapy escalation.

Conclusions:

• Optimizing antibiotic therapy in sepsis requires moving beyond standard dosing to embrace PK/PD-guided individualized approaches.
• Interdisciplinary collaboration and the strategic use of diagnostics and therapeutics are essential for improving sepsis outcomes and managing MDR pathogens.