Clinical Approach to Nosocomial Bacterial Sepsis

Abstract

Bacterial sepsis and septic shock are associated with a high mortality, and when clinically suspected, clinicians must initiate broad-spectrum antimicrobials within the first hour of diagnosis. Thorough review of prior cultures involving multidrug-resistant (MDR) pathogens along with other likely pathogens should be performed to provide an appropriate broad-spectrum empiric antibiotic coverage. The appropriate antibiotic loading dose followed by individualized modification of maintenance dose should be implemented based on the presence of hepatic or renal dysfunction. Use of procalcitonin is no longer recommended to determine need for initial antibacterial therapy and for de-escalation. Daily reevaluation of appropriateness of treatment is necessary based on the culture results and clinical response. All positive cultures should be carefully screened for possible contamination or colonization, which may not represent the true organism causing the sepsis. Culture negative sepsis accounts for one-half of all cases, and de-escalation of initial antibiotic regimen should be done gradually in these patients with close monitoring.

Evaluation of antibiotic efficacy of Ocimum gratissimum L. essential oil against Staphylococcus aureus and Pseudomonas aeruginosa

“…Among the several strains that have emerged and spread in hospitals *Corresponding author. E-mail: orlando.sousa@ufjf.br Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License and communities in different countries, methicillinresistant Staphylococcus aureus (MRSA), which causes meningitis and pneumonia, and Pseudomonas aeruginosa, which affects individuals with compromised immunity (AIDS, cancer, transplant or cystic fibrosis), have been a worldwide public health problem that needs new treatments (Reddy, 2022). Furthermore, from an epidemiological point of view, MRSA is constantly changing, and circulating clones and their antibiotic resistance profiles vary considerably by region and country (Romero and Cunha, 2021).…”

Comparison of efficacy of dopamine versus epinephrine infusion in fluid refractory septic shock in a tertiary care pediatric ICU.

“…4 Septic shock is described as substantial organ dysfunction and increased mortality caused by cellular, metabolic, and circulatory anomalies. 5 Septic shock is associated with excessive nitric oxide (NO) production, which is a factor of great importance in causing vasopressor-resistant hypotension. Mitochondrial dysfunction results in compromised utilization of oxygen at the cellular level and malfunctioning of tissues and organs during sepsis.…”

Molecular Pathways in Sepsis Pathogenesis: Recent Advances and Therapeutic Avenues

“…immune responses, and subsequent infections[21]. Preclinical research continues to be a vital component in the quest to unravel the complexities of sepsis.…”