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11/12/17 1 Antimicrobial Therapy in Sepsis Siu Yan Amy Yeung, PharmD, BCPS Critical Care Clinical Specialist University of Maryland Medical Center Learning Objectives • Explain the optimal time for antimicrobial therapy in a patient with sepsis • Develop an empiric antimicrobial regimen for a patient with sepsis based on patient specific factors • Modify antimicrobial regimen and duration based on patient clinical course and data Antimicrobial Therapy in Sepsis • Recommend that administration of IV antimicrobials be initiated as soon as possible after recognition and within 1 hour for both sepsis and septic shock (Strong recommendation, moderate quality of evidence) • Recommend empiric broad-spectrum therapy with one or more antimicrobials to cover all likely pathogens (Strong recommendation, moderate quality of evidence) • Suggest empiric combination therapy (using at least two antibiotics of different antimicrobial classes) aimed at the most likely bacterial pathogen(s) for the initial management of septic shock (Weak recommendation; low quality of evidence) Rhodes et al. Crit Care Med. 2017; 45:486–552 Timing of Antimicrobials in Sepsis Predicted Hospital Mortality Ferrer et al. Crit Care Med 2014; 42:1749–1755 Inappropriate Antimicrobials Kumar A, et al. Chest 2009;136:1237-1248. Antimicrobial Selection • What is the source of infection? • Prevalence of pathogens in hospital or community • Resistance pattern in hospital or community • Is patient immunocompromised? • Is patient at risk of infection with multi-drug resistant (MDR) organisms? • Is patient at risk for candida infection? • Drug allergies?

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Page 1: Sepsis IPE - Antibiotics in Sepsis review 08.02maryland.ccproject.com/wp-content/uploads/sites/3/2017/...11/12/17 1 Antimicrobial Therapy in Sepsis Siu Yan Amy Yeung, PharmD, BCPS

11/12/17

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AntimicrobialTherapyinSepsis

SiuYanAmyYeung,PharmD,BCPSCriticalCareClinicalSpecialist

UniversityofMarylandMedicalCenter

LearningObjectives

• Explaintheoptimaltimeforantimicrobialtherapyinapatientwithsepsis

• Developanempiricantimicrobialregimenforapatientwithsepsisbasedonpatientspecificfactors

• Modifyantimicrobialregimenanddurationbasedonpatientclinicalcourseanddata

AntimicrobialTherapyinSepsis• RecommendthatadministrationofIVantimicrobialsbeinitiated

assoonaspossibleafterrecognitionandwithin1hourforbothsepsisandsepticshock(Strongrecommendation,moderatequalityofevidence)

• Recommendempiricbroad-spectrumtherapywithoneormoreantimicrobialstocoveralllikelypathogens(Strongrecommendation,moderatequalityofevidence)

• Suggestempiriccombinationtherapy(usingatleasttwoantibioticsofdifferentantimicrobialclasses)aimedatthemostlikelybacterialpathogen(s)fortheinitialmanagementofsepticshock(Weakrecommendation;lowqualityofevidence)

Rhodesetal.Crit CareMed.2017;45:486–552

TimingofAntimicrobialsinSepsisPredictedHospitalM

ortality

Ferreretal.Crit CareMed2014;42:1749–1755

InappropriateAntimicrobials

KumarA,etal.Chest 2009;136:1237-1248.

AntimicrobialSelection

• Whatisthesourceofinfection?• Prevalenceofpathogensinhospitalorcommunity

• Resistancepatterninhospitalorcommunity• Ispatientimmunocompromised?• Ispatientatriskofinfectionwithmulti-drugresistant(MDR)organisms?

• Ispatientatriskforcandidainfection?• Drugallergies?

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11/12/17

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CDCVitalSignsReport.Aug2016.AccessedJune9th 2017

Nose, nasopharynx & sinuses:S. epidermidis, S. aureus, streptococci,

Haemophilus spp., Neisseria spp.

Mouth & Throat:Streptococci, diphtheroids, anaerobes,

S. epidermidis, spirochetes

Intra abdominal:Enterobacteriaceae

(E. coli, Klebsiella), Enterococci, Bacteroides sp., Streptococcus,

Candida sp.

Urinary TractE.coli, Proteus

Skin flora:S. epidermidis, S. aureus,

Diphtheroids (Corynebacterium)

Pneumonia:Community acquired –

S. pneumoniae, H. influenzae, Atypical (M. pneumoniae, C.

pneumoniae, Legionella)Nosocomial - Pseudomonas,

Klebsiella, S. aureus, Acinetobacter

CNS:S. pneumoniae, N. meningitides, ListeriaDevice related: S. aureus, Pseudomonas

AntimicrobialSelection

• Ispatientatriskofinfectionwithmulti-drugresistant(MDR)organisms?• Prolongedhospital(5ormoredays)orlongtermcarefacilitystay

• Priorantimicrobialusewithin90days• PriorinfectionorcolonizationwithMDRorganism

Rhodesetal.Crit CareMed.2017;45:486–552

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11/12/17

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AntifungalSelection

• Ispatientatriskforcandidainfection?• Immunocompromisedstate• Prolongedinvasivevasculardevice• Totalparenteralnutrition• Prolongedadministrationofbroadspectrumantibiotics

• Recentmajorsurgery(especiallyabdominalsurgery)

• MultisitecolonizationRhodesetal.Crit CareMed.2017;45:486–552

AntibioticCombinationTherapy• Increasespectrumofcoverageincreaseprobabilityofappropriateinitialtherapy

• Synergisticeffectincreasepathogenclearance

• Reduceriskforemergenceofresistance

Vazquez-Grandeetal.Semin Respir Crit CareMed.2015;36:154–166

AntimicrobialStewardship• Recommendthatempiricantimicrobialtherapybenarrowedoncepathogenidentificationandsensitivitiesareestablishedand/oradequateclinicalimprovementisnoted(BestPracticeStatement)

• Suggestthatanantimicrobialtreatmentdurationof7-10daysisadequateformostseriousinfectionsassociatedwithsepsisandsepticshock(Weakrecommendation;lowqualityofevidence)

• Recommenddailyassessmentforde-escalationofantimicrobialtherapyinpatientswithsepsisandsepticshock(BestPracticeStatement)

Rhodesetal.Crit CareMed.2017;45:486–552

TakeHomePoints• Initiationofappropriatebroadspectrumantimicrobialsiscrucialinpatientswithsepsis

• Antimicrobialsshouldbegivenwithin1hourafterrecognitionofsepsis

• Broadspectrumantimicrobialsshouldcoverallpotentialpathogens

• Considercombinationantimicrobialsinpatientswithsepticshock

• Antimicrobialsshouldbede-escalatedoncepathogenisidentified,orifpatienthasadequateclinicalresponse

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11/12/17

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InterprofessionalEducationModuletoLearn,Teach,andOptimizetheTreatmentofSepsis

• JeffreyP.Gonzales,PharmD• Nirav G.Shah,MD• ReneeDixon,MD• JoanM.Davenport,RN,PhD• Mojdeh Heavner,PharmD• SamuelA.Tisherman,MD• TraceyWilson,DNP• SiuYanAmyYeung,PharmD• Nimeet Kapoor,RN• PeterP.Olivieri,MD


BCPS Benefits Guide

2021 BCPS Retiree Guide

Ryan Yeung Thesis

sepsis sepsis sepsis sepsis

Effectively Managing Sepsis Denials...Sepsis‐3 “discarded” the concept of SIRS as the basis for defining sepsis and eliminated the distinction between sepsis and severe sepsis

STATEWIDE SEPSIS INITIATIVE - ohiohospitals.org Safety and Quality... · Combined sepsis = POA-Sepsis + HO-Sepsis. Over the years, the proportion of patients with sepsis has increased

Severe Sepsis & Septic Shock. Severe sepsis + septic... · CEM Standards & Sepsis Six 27 ... Act, which focussed on the care of patients with sepsis. ... Severe Sepsis & Septic Shock

BCPS Team Orange

Interview with - Building _e.pdf · Mr Ben S K Yeung, Founder, Ben Yeung & Associates I n 2002, Mr Ben K S Yeung established his own architectural firm Ben Yeung & Associates Ltd

FY21 BCPS Articulation Book

Daisy yeung project

Sepsis Guidelins and STOP SEPSIS

Yeung Singapore Revised[1]

BCPS Facility Utilization Study

Intern Boot Camp: Sepsis Cassie Kovach PGY-3. Outline/Objectives Identification of sepsis Work up of sepsis Triaging sepsis Treatment of sepsis

Sepsis Recognition & Response - Sepsis Pathway Education

file.shd.edu.hkfile.shd.edu.hk/~schdoc/PTA/Textbook_List_for_202021.pdfK.H. Yeung etc. C.M. Yeung & . Yeung etc. Tang Ming Chee & Mui Wai Kwong etc. Aristo Pilot 274.00 230.00 252.10

Photo journal patrick yeung

PASSIVE+ REPORTED SPEECH YEUNG KA HEI(30) + YEUNG YEE MAN(31)

Jacques Yeung Qualifications

October 2013 MASL Angenine Goode agoode@ bcps @ angeninegoode Tatanisha Love tlove@ bcps

The Use of Metabolic Resuscitation in SepsisThe Use of Metabolic Resuscitation in Sepsis Jennifer M. Roth, PharmD, BCPS, BCCCP Critical Care Clinical Specialist - Surgical Trauma ICU

Andy Yeung

Constipation By: Dr. Shahram Ala (Pharm.D, BCPS) (Pharm.D, BCPS)

SIRS- Sepsis-Sepsis Sever

Redefining Sepsis, The End of a SIRS-Era Sepsis PGR slides.pdf · ©2014 MFMER | slide-1 Redefining Sepsis, The End of a SIRS-Era Shannon Piche, PharmD, BCPS PGY-2 Critical Care Resident

Sepsis dan syok sepsis

AKI MIU BCPS 2015

Gerry Yeung OBE

Supplemental Reading Assignments BCPS

Ken Yeung - resume

C. Y. Yeung (CHW, 2009)

BCPS Prospectus

Technology bcps

Sepsis Guidelines - anwresidency.comanwresidency.com/hospitalists/case_conf/icu/Sepsis Guidelines.pdf · Sepsis Guidelines International guidelines for management of severe sepsis