title: Appropriateness is critical.
abstract: Inappropriate empirical antibiotic therapy for severe infections in the intensive care unit is a modifiable prognostic factor that has a great effect on patient outcome and health care resources. Inappropriate treatment is usually associated with microorganisms resistant to the common antibiotics, which must be empirically targeted when risk factors are present. Previous antibiotic exposure, prolonged length of hospital stay, admission category, local susceptibilities, colonization pressure, and the presence of invasive devices increase the likelihood of infection by resistant pathogens. Consideration of issues beyond in vitro susceptibility, such as antibiotic physicochemistry, tissue penetration, and pharmacokinetic/pharmacodynamic-driven dosing, is mandatory for the optimization of antibiotic use.
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Ulldemolins
authors.forename: Xavier
authors.initials: X
authors.lastname: Nuvials
authors.forename: Mercedes
authors.initials: M
authors.lastname: Palomar
authors.forename: Joan R
authors.initials: JR
authors.lastname: Masclans
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection / Q000188:drug therapy*; D024901:Drug Resistance, Multiple, Bacterial; D004358:Drug Therapy / Q000592:standards; D006801:Humans; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents