Empiric Antibiotic Therapy for Severe Sepsis and Septic Shock

Oshima, Taku; Kodama, Yuzo; Takahashi, Waka; Hayashi, Yosuke; Iwase, Shinya; Kurita, Takeo; Saito, Daiki; Yamaji, Yoshihiro; Oda, Shigeto

doi:10.1089/sur.2014.096

Cited by 25 publications

(18 citation statements)

References 20 publications

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“…Meropenem, is an important option for the empirical treatment of cIAIs that exhibits a wide spectrum of activity against a variety of organisms, including polymicrobial, anaerobic bacteria and resistant flora that cause cIAIs. Moreover published treatment guidelines recommend meropenem as monotherapy or combination regimens for postoperative cIAIs (6), which is why we chose it as a comparator. However, empirical antibiotic therapy has been complicated by the growing emergence of drug-resistant organisms, particularly extended-spectrum β-lactamase-producing enterobacteriaceae, and by the overuse of carbapenemresistant bacteria, especially carbapenem-resistant klebsiella pneumoniae.…”

Section: Introductionmentioning

confidence: 99%

A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

Wang

Xing

et al. 2021

Ann Palliat Med

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Background: The efficacy and safety of tigecycline in the treatment of complicated intra-abdominal infections (cIAIs) is potentially controversial. Here we conducted the non-inferiority study to assess the efficacy and safety of tigecycline versus meropenem in the treatment of postoperative cIAIs.Methods: Data of abdominal tumor surgery patients with postoperative cIAIs admitted to intensive care unit (ICU) between October 2017 and December 2019 were collected. A prospective, randomized controlled trial was conducted in which 56 eligible patients with cIAIs randomly received intravenous tigecycline or meropenem for 3 to 14 days. Patients and clinicians were not blinded to the group allocation.Results: The total of 56 patients were enrolled, which were divided into 2 groups, one group included 30 patients receiving meropenem and another group included 26 receiving tigecycline therapy. The 2 groups were similar at demographic and baseline clinical characteristics. Microorganisms were isolated from 46 of 56 patients (82.14%), with a total of 107 pathogens were cultured in two groups. The two groups had similar distribution of infecting microorganisms. The primary end point was the clinical response at the end-oftherapy (EOT) visit and upon discharge visit and comprehensive efficacy. The clinical success rates were 83.33%, 76.67% for meropenem versus 76.92%, 88.46% for tigecycline at the EOT visit and upon discharge visit (P>0.05), respectively. Comprehensive efficacy did not significantly differ between two groups either. There were no significant differences in 30-day and 60-day all-cause mortality between two groups (P>0.05).The univariable analysis identified that serum albumin at admission ICU, colorectal cancer on oncology type, postoperative abdominal bleeding were the risk factors for 60-day all-cause mortality. The multivariable analysis showed that postoperative abdominal bleeding were independent predictors of 60-day all-cause mortality. Gastrointestinal disorders and antibacterials-induced Fungal Infection were the most frequently reported adverse events (AEs). The incidence of AEs was similar between meropenem and tigecycline groups (P>0.05). Conclusions:Taken together, the study demonstrated that tigecycline is as effective and safe as meropenem for postoperative cIAIs in abdominal tumors patients. Tigecycline is non-inferior to meropenem.

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Section: Introductionmentioning

confidence: 99%

A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

Wang

Xing

et al. 2021

Ann Palliat Med

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“…However, the current evidence available is not consistent. Several studies concluded that deescalation therapy was a protective factor associated with lower mortality in patients with severe sepsis, 4,5 while other studies have shown that de-escalation did not effect the mortality, 6,7 but increased the number of antibiotic days and the risk of superinfection. 6 Overall, there is a lack of adequate and firm evidence on whether de-escalation of empiric antibiotics therapy is effective for patients with severe sepsis and/or septic shock, due to the absence of sufficiently powered randomized controlled trials (RCTs).…”

Section: Introductionmentioning

confidence: 99%

De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: A meta-analysis

et al. 2016

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“…With regard to the undesired effects of de‐escalation interventions, one RCT ( n = 116) 104 showed that the 90‐day mortality rate was 78 more per 1,000 (95%CI: 64 fewer to 335 more). On the other hand, the mortality rate due to long‐term follow‐ups in 13 observational studies ( n = 3,635) 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 , 198 , 199 , 200 was 80 fewer per 1,000 (95%CI: 114 fewer to 40 fewer). The quality of the evidence for all of these was “very low.” The incidence of superinfections was 166 more per 1,000 (95%CI: 8 more to 539 more) in the RCTs; however, no observational studies have evaluated these outcomes.…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 98%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Egi

Ogura

Yatabe

et al. 2021

Acute Medicine & Surgery

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created as revised from J‐SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high‐quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J‐SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU‐acquired weakness [ICU‐AW], post‐intensive care syndrome [PICS], and body temperature management). The J‐SSCG 2020 covered a total of 22 areas with four additional new areas (patient‐ and family‐centered care, sepsis treatment system, neuro‐intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large‐scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE‐based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J‐SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

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Empiric Antibiotic Therapy for Severe Sepsis and Septic Shock

Cited by 25 publications

References 20 publications

A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections

De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: A meta-analysis

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

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