Anti-infective therapy

Question 1

What is empiric antimicrobial therapy?

Answer 1

adm before C&S results are available = choice based on experience
adm within 1 hrs sepsis - decrease complications - multiple agents at broad spec

Question 2

What is definitive antimicrobial therapy?

Answer 2

adm after C&S are available

Question 3

Factors determine selection of antimicrobial

Answer 3

1. site/source infec
2. causative pathogens
3. community / nosocomial - hopsital acquired infection
4. immune status of patient
5. antibiotic susceptibility + resistance profile
6. patient history
7. adverse reactions
8. costs

Question 4

Strategy to antimicrobial treatment

Answer 4

1. adm within 1st hr sepsis
2. collect appropriate cultures
3. adm antimicrobials that concentrate at site of infec
4. monitor patient parameters to ensure adequate dosing
5. abnormal renal + hepatic function = increase drug concentrations = avoid toxicity
6. once renal funtion norma - change antibiotic dosing
7. initial large vol resuscitation + cause increase Vd
8. re-evaulate intiial dosing regime on daily basis
9. step down therapy - IV–> oral
10. monotherapy

Question 5

Duration of anti-infective therapy

Answer 5

• 7-10 days

- vary depends site of infect + response

Question 6

when is step down therapy recommended

Answer 6

• haemodynamically stable
• afebrible 48-72hrs
• normalize WBC
• organism susceptibel to oral therapies
• able to take oral med

Question 7

Types of source control measures

Answer 7

1. drainage + debridement
2. device removal - gastrostomy tube
3. prevention - hand hygien

Question 8

complications of source control measures

Answer 8

1. bleeding
2. fistulas
3. organ injury