Therapy of sepsis.
The term 'sepsis' is often used synonymously with 'infection' or 'bacteremia'. Additional definitions, e.g. 'systemic inflammatory response syndrome', have been proposed. These terms have been employed to establish entry criteria for clinical trials of antibiotic therapy and adjunctive therapies. It may be appropriate to utilize these descriptions when initiating therapy of suspected bacterial infections, since culture confirmation is often not available for days after initial clinical presentation. Empiric antibiotic therapy is now the rule rather than the exception for febrile hospitalized patients. No antimicrobial agent is superior for all major clinical situations and thus history and physical examination are critical factors which guide the clinician. Guidelines have been derived for the initial empiric management of serious infection. While these were initially refined for the immunocompromized host, they may be considered generally applicable for the hospitalized patient with a suspected serious systemic bacterial infection. Currently, monotherapy with agents such as cefepime, ceftazidime, imipenem/cilastatin and meropenem has been sanctioned on the basis of their broad antimicrobial coverage and stability to clinically important beta-lactamases (although there is considerable variation from one compound to another). Perception of local epidemiologic patterns is a major factor in the selection of initial antibacterial therapy for hospital-acquired infection.
Young
Lowell S.
LS
Kuzell Institute for Arthritis and Infectious Diseases, California Pacific Medical Center Research Institute, San Francisco, USA.