Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review
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...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-03-01
|
| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/11/3/362 |
| _version_ | 1797473193186820096 |
|---|---|
| author | Alexis Tabah Jeffrey Lipman François Barbier Niccolò Buetti Jean-François Timsit on behalf of the ESCMID Study Group for Infections in Critically Ill Patients—ESGCIP |
| author_facet | Alexis Tabah Jeffrey Lipman François Barbier Niccolò Buetti Jean-François Timsit on behalf of the ESCMID Study Group for Infections in Critically Ill Patients—ESGCIP |
| author_sort | Alexis Tabah |
| collection | DOAJ |
| description | 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 β-lactamase-producing, AmpC-hyperproducing and carbapenem-resistant Enterobacterales; carbapenem-resistant <i>Acinetobacter baumannii;</i> and <i>Staphylococcus aureus</i>. In order to improve clinical outcomes, dosing recommendations and pharmacokinetics/pharmacodynamics specific to ICU patients must be followed, alongside therapeutic drug monitoring. |
| first_indexed | 2024-03-09T20:11:23Z |
| format | Article |
| id | doaj.art-24381da790d54c43a1c4cdb591148f6d |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T20:11:23Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-24381da790d54c43a1c4cdb591148f6d2023-11-24T00:11:20ZengMDPI AGAntibiotics2079-63822022-03-0111336210.3390/antibiotics11030362Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented ReviewAlexis Tabah0Jeffrey Lipman1François Barbier2Niccolò Buetti3Jean-François Timsit4on behalf of the ESCMID Study Group for Infections in Critically Ill Patients—ESGCIPIntensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health Services, Redcliffe, QLD 4020, AustraliaAntimicrobial Optimisation Group, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, AustraliaMedical Intensive Care Unit, CHR Orléans, 45100 Orléans, FranceIAME, INSERM, Université de Paris, 75018 Paris, FranceIAME, INSERM, Université de Paris, 75018 Paris, FranceBloodstream 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 β-lactamase-producing, AmpC-hyperproducing and carbapenem-resistant Enterobacterales; carbapenem-resistant <i>Acinetobacter baumannii;</i> and <i>Staphylococcus aureus</i>. In order to improve clinical outcomes, dosing recommendations and pharmacokinetics/pharmacodynamics specific to ICU patients must be followed, alongside therapeutic drug monitoring.https://www.mdpi.com/2079-6382/11/3/362bloodstream infectionbacteraemiasepsisseptic shockempiricalprobabilistic antibiotics |
| spellingShingle | Alexis Tabah Jeffrey Lipman François Barbier Niccolò Buetti Jean-François Timsit on behalf of the ESCMID Study Group for Infections in Critically Ill Patients—ESGCIP Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review Antibiotics bloodstream infection bacteraemia sepsis septic shock empirical probabilistic antibiotics |
| title | Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review |
| title_full | Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review |
| title_fullStr | Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review |
| title_full_unstemmed | Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review |
| title_short | Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review |
| title_sort | use of antimicrobials for bloodstream infections in the intensive care unit a clinically oriented review |
| topic | bloodstream infection bacteraemia sepsis septic shock empirical probabilistic antibiotics |
| url | https://www.mdpi.com/2079-6382/11/3/362 |
| work_keys_str_mv | AT alexistabah useofantimicrobialsforbloodstreaminfectionsintheintensivecareunitaclinicallyorientedreview AT jeffreylipman useofantimicrobialsforbloodstreaminfectionsintheintensivecareunitaclinicallyorientedreview AT francoisbarbier useofantimicrobialsforbloodstreaminfectionsintheintensivecareunitaclinicallyorientedreview AT niccolobuetti useofantimicrobialsforbloodstreaminfectionsintheintensivecareunitaclinicallyorientedreview AT jeanfrancoistimsit useofantimicrobialsforbloodstreaminfectionsintheintensivecareunitaclinicallyorientedreview AT onbehalfoftheescmidstudygroupforinfectionsincriticallyillpatientsesgcip useofantimicrobialsforbloodstreaminfectionsintheintensivecareunitaclinicallyorientedreview |