Bloodstream infections in critically ill patients: an expert statement

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Antimicrobial Stewardship

Background:

• Bloodstream infection (BSI) presents with systemic signs and positive blood cultures, originating from a known source or primarily.
• Community-acquired BSIs typically involve susceptible bacteria, whereas healthcare-associated BSIs often feature multidrug-resistant (MDR) strains.

Purpose of the Study:

• To review the epidemiology, diagnostic workflow, and therapeutic strategies for BSIs in ICU patients.
• To provide up-to-date expert statements on managing BSIs in critical care settings.

Main Methods:

• This narrative review synthesizes current knowledge on BSI management.
• It considers factors influencing antimicrobial choice, including local epidemiology and patient status.

Main Results:

• Early, appropriate antimicrobial therapy is crucial for improving patient outcomes, particularly in sepsis or septic shock.
• Consideration of local MDR prevalence, patient history, and early diagnostic tests aids in selecting first-line antimicrobials.
• Source control and de-escalation of therapy can optimize treatment and reduce resistance pressure.

Conclusions:

• Optimal BSI management in ICUs involves a multi-faceted approach, including timely diagnosis, tailored antimicrobial therapy, and source control.
• Adjusting antimicrobial dosing for critically ill patients and considering combination therapy for MDR pathogens are key.
• Duration of therapy should be individualized, typically 5-8 days, with potential for longer courses based on clinical context.