Abstract
Over the past decade, trends in antimicrobial resistance, epidemiology, and drug development have occurred that affect both the empiric and definite selection of antimicrobials in the septic patient. The rapid spread of highly pathogenic community-associated methicillin resistant Staph aureus (MRSA) requires clinicians to consider the inclusion of empiric coverage for MRSA even in community- acquired sepsis. Moreover, vancomycin appears to be losing its effectiveness, and while a number of new agents with broad gram positive activity have been licensed, none have emerged as clearly superior. An alarming increase in the number of hospital-acquired infections due to multi-drug resistant gram negative bacteria has also occurred, and few new gram negative drugs are in development. Clinicians, faced with Pseudomonas aeruginosa or Acinetobacter baumanii isolates resistant to all commonly used drugs, must resort to toxic older drugs such as colistin or therapy combining drugs not effective as monotherapy. Based on a desire to limit overall antimicrobial use, a re-evaluation of older data in both the neutropenic and non-neutropenic host has called into question the common practice of using combination therapy for some gram negative infections. An emerging consensus advocates emphasizing local unit specific antimicrobial sensitivity data in selecting empiric therapy and determining if combination therapy is required. New antifungal drugs and a better understanding of the risk factors for infection with Candida spp. has altered the approach to empiric and definitive treatment of Candida infections in the septic patient.
Keywords: Sepsis, antimicrobial therapy, septic shock
Current Pharmaceutical Design
Title: New Developments in Antimicrobial Use in Sepsis
Volume: 14 Issue: 19
Author(s): Daniel R. Kaul, Curtis D. Collins and Robert C. Hyzy
Affiliation:
Keywords: Sepsis, antimicrobial therapy, septic shock
Abstract: Over the past decade, trends in antimicrobial resistance, epidemiology, and drug development have occurred that affect both the empiric and definite selection of antimicrobials in the septic patient. The rapid spread of highly pathogenic community-associated methicillin resistant Staph aureus (MRSA) requires clinicians to consider the inclusion of empiric coverage for MRSA even in community- acquired sepsis. Moreover, vancomycin appears to be losing its effectiveness, and while a number of new agents with broad gram positive activity have been licensed, none have emerged as clearly superior. An alarming increase in the number of hospital-acquired infections due to multi-drug resistant gram negative bacteria has also occurred, and few new gram negative drugs are in development. Clinicians, faced with Pseudomonas aeruginosa or Acinetobacter baumanii isolates resistant to all commonly used drugs, must resort to toxic older drugs such as colistin or therapy combining drugs not effective as monotherapy. Based on a desire to limit overall antimicrobial use, a re-evaluation of older data in both the neutropenic and non-neutropenic host has called into question the common practice of using combination therapy for some gram negative infections. An emerging consensus advocates emphasizing local unit specific antimicrobial sensitivity data in selecting empiric therapy and determining if combination therapy is required. New antifungal drugs and a better understanding of the risk factors for infection with Candida spp. has altered the approach to empiric and definitive treatment of Candida infections in the septic patient.
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Cite this article as:
Kaul R. Daniel, Collins D. Curtis and Hyzy C. Robert, New Developments in Antimicrobial Use in Sepsis, Current Pharmaceutical Design 2008; 14 (19) . https://dx.doi.org/10.2174/138161208784980608
DOI https://dx.doi.org/10.2174/138161208784980608 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
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