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Published on: August 12, 2020
Calculated initial parenteral treatment of bacterial infections: Sepsis
Klaus-Friedrich Bodmann1, Rainer Höhl2, Wolfgang Krüger3
1Klinik für Internistische Intensiv- und Notfallmedizin und Klinische Infektiologie, Klinikum Barnim GmbH, Werner Forßmann Krankenhaus, Eberswalde, Germany.
Insights
Early, effective antimicrobial therapy is crucial for treating sepsis, a life-threatening condition. Optimizing treatment involves considering patient history, local epidemiology, and future plasma concentration monitoring for better outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Clinical Pharmacology
Background:
- Sepsis is a leading cause of death in Germany, with high mortality rates.
- Effective antimicrobial therapy, alongside source control, is vital for sepsis management.
- Current guidelines emphasize calculated initial parenteral treatment for bacterial infections.
Purpose of the Study:
- To provide an internationally accessible translation of the German Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) guideline on sepsis treatment.
- To highlight the importance of early, effective antimicrobial therapy in sepsis management.
- To discuss considerations for modifying initial broad-spectrum antibiotic therapy and future directions.
Main Methods:
- Translation of the "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" guideline.
- Review of factors influencing therapeutic decisions, including prior antimicrobial therapy, patient history, and epidemiology.
- Discussion of the role of plasma concentration monitoring and interdisciplinary collaboration.
Main Results:
- Sepsis necessitates prompt antimicrobial therapy and source control for improved survival.
- Therapeutic decisions should integrate patient-specific factors and local resistance patterns.
- Future strategies may involve optimizing antimicrobial dosing through plasma concentration monitoring.
Conclusions:
- Early and effective antimicrobial treatment is paramount in managing sepsis.
- Personalized therapeutic approaches, considering patient history and epidemiology, are essential.
- Interdisciplinary collaboration and antimicrobial stewardship programs are crucial for optimizing sepsis care and combating resistance.
Abstract:
This is the eleventh chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. Sepsis, defined as a life threatening organ dysfunction caused by a misregulated host response to an infection, is the third leading cause of death in Germany with a lethality rate of 30% to over 50%. An early, effective antimicrobial therapy is, next to infectious source control, the most important causal treatment option. It should be complemented by the mainly supportive measures of general intensive care therapy. Prior antimicrobial therapy, the patient's medical history (e.g. risk factors for multiresistant agents) and small-scale epidemiology are to be considered as part of the therapeutic and practical decisions. A modification of the often needed broad initial calculated combination therapy is desirable. In the future, prompt measurements of plasma concentrations of antiinfectives, especially for the sepsis patient with diverse and partly conflicting pathophysiological changes, will have great importance regarding efficacy, toxicity and resistance development. In order to apply those complex strategies in clinical routine, there is a requirement for a strong interdisciplinary collaboration between the intensive care unit, clinical infectiology, microbiology, and clinical pharmacology, ideally in the framework of a functional antimicrobial stewardship program.
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