title: Treatment of bloodstream infections in ICUs.
abstract: Bloodstream infections (BSIs) are frequent in ICU and is a prognostic factor of severe sepsis. Community acquired BSIs usually due to susceptible bacteria should be clearly differentiated from healthcare associated BSIs frequently due to resistant hospital strains. Early adequate treatment is key and should use guidelines and direct examination of samples performed from the infectious source. Previous antibiotic therapy knowledge, history of multi-drug resistant organism (MDRO) carriage are other major determinants of first choice antimicrobials in heathcare-associated and nosocomial BSIs. Initial antimicrobial dose should be adapted to pharmacokinetic knowledge. In general, a high dose is recommended at the beginning of treatment. If MDRO is suspected combination antibiotic therapy is mandatory because it increase the spectrum of treatment. Most of time, combination should be pursued no more than 2 to 5 days.Given the negative impact of useless antimicrobials, maximal effort should be done to decrease the antibiotic selection pressure. De-escalation from a broad spectrum to a narrow spectrum antimicrobial decreases the antibiotic selection pressure without negative impact on mortality. Duration of therapy should be shortened as often as possible especially when organism is susceptible, when the infection source has been totally controlled.
authors.affiliation: INSERM, IAME, UMR 1137, F-75018 Paris, France. jean-francois.timsit@bch.aphp.fr.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Soubirou
authors.forename: Guillaume
authors.initials: G
authors.lastname: Voiriot
authors.forename: Sarah
authors.initials: S
authors.lastname: Chemam
authors.forename: Mathilde
authors.initials: M
authors.lastname: Neuville
authors.forename: Bruno
authors.initials: B
authors.lastname: Mourvillier
authors.forename: Romain
authors.initials: R
authors.lastname: Sonneville
authors.forename: Eric
authors.initials: E
authors.lastname: Mariotte
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents