Appropriateness of empirical antibiotic therapy and added value of adjunctive gentamicin in patients with septic shock: a prospective cohort study in the ICU

Autor:	Rob G. H. Driessen, Dirk Posthouwer, Guy J. Oudhuis, Johan van Koll, Rald V M Groven, Iwan C. C. van der Horst, Dennis C J J Bergmans, Ronny M. Schnabel
Přispěvatelé:	MUMC+: MA Medische Staf IC (9), MUMC+: MA Med Staf Spec Cardiologie (9), RS: Carim - V04 Surgical intervention, Med Microbiol, Infect Dis & Infect Prev, MUMC+: DA MMI Staf (9), Intensive Care, MUMC+: MA Intensive Care (3), MUMC+: MA Arts Assistenten IC (9), RS: NUTRIM - R2 - Liver and digestive health
Rok vydání:	2021
Předmět:	0301 basic medicine Microbiology (medical) medicine.medical_specialty 030106 microbiology gentamicin Sepsis 03 medical and health sciences 0302 clinical medicine Intensive care Antibiotic therapy medicine antibiotic therapy MANAGEMENT Humans In patient 030212 general & internal medicine Prospective Studies Intensive care medicine Prospective cohort study intensive care General Immunology and Microbiology business.industry Septic shock Aminoglycoside General Medicine medicine.disease Shock Septic Anti-Bacterial Agents CAMPAIGN INTERNATIONAL GUIDELINES SEVERE SEPSIS Intensive Care Units Infectious Diseases RISK-FACTORS SURVIVAL septic shock aminoglycoside Gentamicin Gentamicins business BLOOD-STREAM INFECTIONS medicine.drug
Zdroj:	Infectious Diseases, 53(11), 830-838. Routledge/Taylor & Francis Group
ISSN:	2374-4243 2374-4235
Popis:	Objectives To determine the appropriateness of empiric antibiotic therapy and the possible benefit of adding short-course gentamicin in septic shock patients with abdominal, urogenital, or an unknown focus. Secondary objectives were the effect of gentamicin addition on shock reversal and the incidence of a fungal infection. Methods Microbiological cultures, antibiotic treatment, and antibiotic resistance patterns of the cultured microorganisms were recorded during the first 5 days of admission. Inappropriate antibiotic therapy was defined as a prescription within the first 24 h that did not cover cultured bacteria during the first 5 days of admission and was determined in the overall group and in patients receiving adjunctive gentamicin (combination therapy) versus patients receiving monotherapy. Binomial logistic regression analysis was used to investigate the association of gentamicin addition with shock reversal. Results Of 203 septic shock patients, with abdominal (n = 143), urogenital (n = 27) or unknown (n = 33) focus, 115 patients received monotherapy, and 88 patients received combination therapy. Inappropriate therapy occurred in 29 patients (14%), more frequently in monotherapy (17%) versus combination therapy (10%). Combination therapy would have been effective in 55% of patients with inappropriate monotherapy. We found no association between gentamicin addition and shock reversal (p = .223). A fungal infection was present in 22 patients (11%). Conclusion Inappropriate empirical antibiotic therapy occurs in 17% of septic shock patients receiving monotherapy. In 55% of these patients, additional gentamicin would have resulted in appropriate therapy. When clinical course is unfavourable, lowering the threshold for administering adjunctive aminoglycoside and antifungal therapy should be considered.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b693a14511b476cf6dbde4a0aeea43a7 https://pubmed.ncbi.nlm.nih.gov/34156899 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
Nepřihlášeným uživatelům se plný text nezobrazuje	K zobrazení výsledku je třeba se přihlásit.