Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review

被引:18
作者
Tabah, Alexis [1 ,2 ,3 ]
Lipman, Jeffrey [3 ,4 ,5 ,6 ]
Barbier, Francois [7 ]
Buetti, Niccolo [8 ,9 ,10 ,11 ]
Timsit, Jean-Francois [8 ,12 ]
机构
[1] Redcliffe Hosp, Metro North Hosp & Hlth Serv, Intens Care Unit, Redcliffe, Qld 4020, Australia
[2] Queensland Univ Technol, Sch Clin Sci, Brisbane, Qld 4000, Australia
[3] Univ Queensland, UQ Ctr Clin Res, Antimicrobial Optimisat Grp, Brisbane, Qld 4029, Australia
[4] Metro North Hosp & Hlth Serv, Royal Brisbane & Womens Hosp, Jamieson Trauma Inst, Brisbane, Qld 4029, Australia
[5] Metro North Hosp & Hlth Serv, Royal Brisbane & Womens Hosp, Intens Care Serv, Brisbane, Qld 4029, Australia
[6] Univ Montpellier, Nimes Univ Hosp, Div Anaesthesiol Crit Care Emergency & Pain Med, F-30029 Nimes, France
[7] CHR Orleans, Med Intens Care Unit, F-45100 Orleans, France
[8] Univ Paris, INSERM, IAME, F-75018 Paris, France
[9] Geneva Univ Hosp, Infect Control Program, Rue Gabrielle Perret Gentil 4, CH-1205 Geneva, Switzerland
[10] Geneva Univ Hosp, WHO Collaborating Ctr Patient Safety, Rue Gabrielle Perret Gentil 4, CH-1205 Geneva, Switzerland
[11] Fac Med, Rue Gabrielle Perret Gentil 4, CH-1205 Geneva, Switzerland
[12] Bichat Claude Bernard Hosp, AP HP, Med & Infect Dis Intens Care Unit MI, F-75018 Paris, France
来源
ANTIBIOTICS-BASEL | 2022年 / 11卷 / 03期
关键词
bloodstream infection; bacteraemia; sepsis; septic shock; empirical; probabilistic antibiotics; source control; de-escalation; ICU; intensive care; CRITICALLY-ILL PATIENTS; GRAM-NEGATIVE BACTERIA; ATTRIBUTABLE MORTALITY; DISEASES SOCIETY; SEVERE SEPSIS; RESISTANCE; THERAPY; ANTIBIOTICS; DURATION; METAANALYSIS;
D O I
10.3390/antibiotics11030362
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Bloodstream infections (BSIs) in critically ill patients are associated with significant mortality. For patients with septic shock, antibiotics should be administered within the hour. Probabilistic treatment should be targeted to the most likely pathogens, considering the source and risk factors for bacterial resistance including local epidemiology. Source control is a critical component of the management. Sending blood cultures (BCs) and other specimens before antibiotic administration, without delaying them, is key to microbiological diagnosis and subsequent opportunities for antimicrobial stewardship. Molecular rapid diagnostic testing may provide faster identification of pathogens and specific resistance patterns from the initial positive BC. Results allow for antibiotic optimisation, targeting the causative pathogen with escalation or de-escalation as required. Through this clinically oriented narrative review, we provide expert commentary for empirical and targeted antibiotic choice, including a review of the evidence and recommendations for the treatments of extended-spectrum beta-lactamase-producing, AmpC-hyperproducing and carbapenem-resistant Enterobacterales; carbapenem-resistant Acinetobacter baumannii; and Staphylococcus aureus. In order to improve clinical outcomes, dosing recommendations and pharmacokinetics/pharmacodynamics specific to ICU patients must be followed, alongside therapeutic drug monitoring.
引用
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页数:20
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