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