Bugs and Drugs in Sepsis

Let’s get the coverage appropriate

Gram Stain – about 50% accurate in the setting of blood cultures

When we inadequately cover bacteremia – 22% mortality

When we inadequately cover pneumonia – 31% mortality

Timing of antibiotics (Kumar et al 2006)

For every hour of delay – mortality increases approximately 10%

When do we double coverage for pseudomonas, acinetobacter and gram negatives?

Neutropenic / other HCAP risk factors

Previous culture positivitiy

Severe sepsis

In a paper by Chastre et al 2003, it was shown that 8 and 15 days had equal efficacy in prevention of VAP in intubated pneumonia patients

Remember guidelines should be institution (and even unit) dependent due to sesitivities 90% sensitivity to cephalexin for E.Coli, 80% for trimeth-sulfa at UCMC,



Why do my antibiotics have varying infusions and timings? It depends on what level of antibiotic you need for what duration of time

Time depedent (60% at least time at MIC)

Peak dependent (think aminoglycosides)

AUC/MIC (vancomycin)

Make sure to check out Fighting the Bugs (case 1), Sepsis Under Fire (case 2) and soon-to-be-posted curated summary of comments on their two prior posts on sepsis!