title: Advances in antibiotic therapy in the critically ill.
abstract: Infections occur frequently in critically ill patients and their management can be challenging for various reasons, including delayed diagnosis, difficulties identifying causative microorganisms, and the high prevalence of antibiotic-resistant strains. In this review, we briefly discuss the importance of early infection diagnosis, before considering in more detail some of the key issues related to antibiotic management in these patients, including controversies surrounding use of combination or monotherapy, duration of therapy, and de-escalation. Antibiotic pharmacodynamics and pharmacokinetics, notably volumes of distribution and clearance, can be altered by critical illness and can influence dosing regimens. Dosing decisions in different subgroups of patients, e.g., the obese, are also covered. We also briefly consider ventilator-associated pneumonia and the role of inhaled antibiotics. Finally, we mention antibiotics that are currently being developed and show promise for the future.
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, 1070, Brussels, Belgium. jlvincent@intensive.org.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, 33100, Udine, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: Service de Réanimation Polyvalente, CHU de Dupuytren, 87042, Limoges, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: François
authors.affiliation: Infectious Disease Section, Louisiana State University School of Medicine, 70112, New Orleans, LA, USA.
authors.forename: George
authors.initials: G
authors.lastname: Karam
authors.affiliation: Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.affiliation: Department of Pulmonary Medicine, Hospital Clinic of Barcelona, IDIBAPS-Ciberes, 08036, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.affiliation: Burns, Trauma and Critical Care Research Centre, The University of Queensland, Royal Brisbane and Women's Hospital, 4029 Herston, Brisbane, Australia.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, 1070, Brussels, Belgium.
authors.forename: Fabio S
authors.initials: FS
authors.lastname: Taccone
authors.affiliation: Department of Intensive care, CIBERES, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, 08035, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois, University of Lausanne, 1011, Lausanne, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Calandra
authors.affiliation: Department of Intensive Care, CHIREC Hospital, Université Libre de Bruxelles, 1420, Braine L'Alleud, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
authors.affiliation: Department of Respiratory Medicine, Medizinische Hochschule, 30625, Hannover, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D016638:Critical Illness; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents