title: A consensus statement on empiric therapy for suspected gram-positive infections in surgical patients.
abstract: BACKGROUND
  Multidrug resistance among gram-positive pathogens in tertiary and other care centers is common. A systematic decision pathway to help select empiric antibiotic therapy for suspected gram-positive postsurgical infections is presented.
  
  
  METHODS
  A Medline search with regard to empiric antibiotic therapy was performed and assessed by the 15-member expert panel. Two separate panel meetings were convened and followed by a writing, editorial, and review process.
  
  
  CONCLUSIONS
  The main goal of empiric treatment in postsurgical patients with suspected gram-positive infections is to improve clinical status. Empiric therapy should be initiated at the earliest sign of infection in all critically ill patients. The choice of therapy should flow from beta-lactams to vancomycin to parenteral linezolid or quinupristin-dalfopristin. In patients likely to be discharged, oral linezolid is an option. Antibiotic resistance is an important issue, and in developing treatment algorithms for reduction of resistance, the utility of these new antibiotics may be extended and reduce morbidity and mortality.
authors.affiliation: Division of Trauma and Critical Care, University of Cincinnati College of Medicine, Cincinnati, OH, USA. joseph.solomkin@uc.edu
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Solomkin
authors.forename: H Stephen
authors.initials: HS
authors.lastname: Bjornson
authors.forename: Miguel
authors.initials: M
authors.lastname: Cainzos
authors.forename: E Patchen
authors.initials: EP
authors.lastname: Dellinger
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Dominioni
authors.forename: Robert
authors.initials: R
authors.lastname: Eidus
authors.forename: Eugen
authors.initials: E
authors.lastname: Faist
authors.forename: David
authors.initials: D
authors.lastname: Leaper
authors.forename: James T
authors.initials: JT
authors.lastname: Lee
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Lipsett
authors.forename: Lena
authors.initials: L
authors.lastname: Napolitano
authors.forename: Carl L
authors.initials: CL
authors.lastname: Nelson
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
authors.forename: John
authors.initials: J
authors.lastname: Weigelt
authors.forename: Samuel Eric
authors.initials: SE
authors.lastname: Wilson
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D003663:Decision Trees; D024881:Drug Resistance, Bacterial; D036262:Empirical Research; D016983:Enterococcus / Q000187:drug effects; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D016106:Methicillin Resistance; D011183:Postoperative Complications / Q000188:drug therapy* / Q000191:economics; D013210:Staphylococcus / Q000187:drug effects; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents