title: The role of antimicrobials in the treatment of sepsis and critical illness-related bacterial infections: examination of the evidence.
abstract: OBJECTIVE
  To appraise the evidence behind the Surviving Sepsis Campaign Guidelines on antimicrobial therapy in sepsis and evaluate relevant literature in small animal veterinary critical care.
  
  
  METHODS
  Electronic searches using MEDLINE and EMBASE databases.
  
  
  RESULTS
  Current recommendations are to administer appropriate antimicrobials within 1 hour of a diagnosis of severe sepsis or septic shock. Evidence is supportive of this recommendation in septic shock but the evidence is less compelling in milder forms of critical illness-related infections. It is unclear when the administration of appropriate antimicrobials is most beneficial and when it should be considered essential. Evidence supports shorter courses of antimicrobial therapy for many infections seen in the critical care unit with the biomarkers procalcitonin and C-reactive protein helpful in guiding the duration of therapy.
  
  
  RESULTS
  Current evidence is lacking to support the use of early and aggressive use of antimicrobials in all patients with critical illness-related bacterial infections. Two studies failed to demonstrate improved survival in patients with pulmonary or abdominal infections administered appropriate vs inappropriate empirical antimicrobials. One study failed to show an improved survival when dogs with abdominal infections were administered antimicrobials within 1 hour vs 6 hours of diagnosis of infection. Information regarding ideal duration of antimicrobial therapy and use of biomarkers to guide therapy is currently lacking.
  
  
  CONCLUSIONS
  Clinicians should aim to administer early and appropriate antimicrobials; however, the impact this will have on patient outcome remains uncertain. The ability to administer early and appropriate antimicrobials may be considered a measure of the quality of medical practice rather than a prognostic indicator.
authors.affiliation: From the Center for Critical Care Nephrology, Department of Critical Care Medicine, The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Iain
authors.initials: I
authors.lastname: Keir
authors.forename: Amy E
authors.initials: AE
authors.lastname: Dickinson
mesh_terms: D000818:Animals; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000662:veterinary*; D002371:Cat Diseases / Q000188:drug therapy*; D002415:Cats; D003422:Critical Care; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D012772:Shock, Septic / Q000188:drug therapy / Q000662:veterinary*; D014730:Veterinary Medicine
chemical_list: D000890:Anti-Infective Agents
keywords: bacterial resistance; biomarkers; timing of therapy