TREATING SEPSIS

      
   

 

      
     

Step E: Empiric Therapy - Antibiotics

The selection of specific antibiotics depends on:

  • The presumed site of infection (see table 1 below).
  • Gram's stain results
  • Suspected or known organisms
  • Resistance patterns of the common hospital microbial flora.
  • Patient’s immune status (especially neutropenia and immunosuppressive drugs), allergies, renal dysfunction, and hepatic dysfunction.
  • Antibiotic availability, hospital resistance patterns, and clinical variables of patient to be treated

Table 1: Frequency of Source of Infection

Respiratory Tract                  25%

Abdominal / Pelvic                25%

Bacteremia                            15%

Urinary Tract                          10%

Skin                                        5%

IV Catheter                             5%

Other source                          15%

In intensive care units approximately 25% of infections are confirmed gram negative, 25% gram positive, 20% mixed gram positive/gram negative, and 3% fungal. Of the gram negative organisms, the organisms in order of likelihood are e.coli (25%), klebsiellla/citrobacter (20%), pseudomonas (15%), enterobacter (10%) and proteus (5%); the remaining 25% is made up of dozens of different bacteriae. Of the gram positive infections, by far the most common is staphylococcus aureus (35%), followed by enterococcus (20%), coagulase negative staphylococcus (15%) and streptococcus pneumoniae (10%). The vast majority of fungal infections are candidal.

        
   

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