huddinge controversies in the treatment of sepsis – the use and misuse of antibiotics in the icu...
TRANSCRIPT
Huddinge
Controversies in the treatment of sepsis – the use and misuse of antibiotics in the ICU
Conclusions
SSAC Iceland 2005
Bengt Gårdlund, Dpt of Infectious Diseases
Early appropriate antibiotics vital
for survival in sepsis
Message:
Problem:Antibiotic overuse vs patient’s safety
Strategy for rational use of antibiotics in sepsis
Improve accuracy of empiric antibiotics Reduce inappropriate use of antibiotics Narrow down antibiotics after culture results Avoid unnecessarily long treatments
Each patient deserves inividual consideration
Accuracy in antibiotic choice can be improved with education & training.
Messages:
No support for antibiotic prophylaxis in trauma
for more than 24 h
Message:
Short prophylaxis for penetrating abdominal trauma.
Messages:
No support for more thanone dose of antibiotic
prophylaxis in elective surgery
Leads to secondary infections and nosocomial infections with
MR resistant pathogens
Messages:
Do not treat airway cultures with
CNSCandidaEnterococci
Aggressive diagnostics reduce need for antibiotics
Treat VAP for 8 d. Longer if Pseudomonas or necrotizing pneumonia
Messages:
Effect of evidence based sepsis strategies
0
10
20
30
40
50
60
70
Riversconcept
Cortisone APC Glucosecontrol
Antibiotics
Mo
rta
lity
%
Antibiotics in the ICU - summary
We need to use the antibiotics we have more wisely
Early empiric antibiotics in sepsis Improve accuracy of empiric antibiotics
Reduce inappropriate use of antibioticsShort prophylaxisAggressive diagnostic strategyNarrow down antibiotics after culture resultsTerminate antibiotics when initial suspicion of
sepsis was disprovedAvoid unnecessarily long treatment durationAvoid compassionate use of antibiotics