Broad‐Spectrum Antimicrobials and the Treatment of Serious Bacterial Infections: Getting It Right Up Front

Abstract

The treatment of serious bacterial infections is complicated by the fact that time to initiation of effective antimicrobial therapy is a strong predictor of mortality. Therefore, therapy must be initiated before the causative pathogen is identified. However, inappropriate or inadequate initial empirical therapy is associated with increased mortality, morbidity, and length of hospital stay. Initial empirical therapy with broad-spectrum antimicrobials attempts to address this dilemma by "getting it right up front." The goal is to provide treatment active against the most likely pathogens until culture/susceptibility test results are obtained. After the causative pathogen is identified, streamlining to more-precise therapy of the shortest acceptable duration is implemented. In this way, the risks of death, morbid complications, increased duration of hospital stay (as a result of ineffective initial treatment), and emergence of resistance (due to extended treatment with broad-spectrum agents) are lowered. Improved clinical and economic outcomes after such an approach have been demonstrated.

Pseudomonas aeruginosaNosocomial Pneumonia: Impact of Pneumonia Classification

“…16 Antimicrobial treatment was deemed to represent IIAT if the initially prescribed antibiotic regimen was not active against the identified isolate on the basis of in vitro susceptibility testing or was administered more than 24 hours following respiratory specimen collection. 17 Microbiology laboratories determined antimicrobial susceptibility of the isolates using disk diffusion or automated testing methods according to established guidelines and breakpoints. 18,19 …”

Rapid Identification of Bacteria from Positive Blood Culture Bottles by Use of Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry Fingerprinting

“…Thus, final results often arrive more than 72 h from sampling (17), with a minor impact on antimicrobial usage (30). Since the outcome for septic patients has been shown to depend on the adequacy of early antimicrobial chemotherapy, vital treatment decisions currently often rely on empirical knowledge and vague pathogen characterization by light microscopy (18,30). Thus, more-rapid identification of the causative organism would be highly desirable to facilitate targeted treatment in the critical phase of septic illness (10).…”

Bacterial Profile of Lower Respiratory Tract Infections in Adults and their Antibiotic Susceptibility Pattern with Detection of MRSA, ESBLs and MBLs

“…Knowledge of the prevalence of pathogens in the local context can help to devise an antibiotic policy. This can reduce mortality and prevent development of complications (Kollef et al, 2008). Broad spectrum therapy can be narrowed down after the culture reports.…”