Huddinge Controversies in the treatment of sepsis – the use and misuse of antibiotics in the ICU Conclusions SSAC Iceland 2005 Bengt Gårdlund, Dpt of Infectious Diseases

Early appropriate antibiotics vital for survival in sepsis Message:

Problem: Antibiotic overuse vs patient’s safety

Strategy for rational use of antibiotics in sepsis  Improve accuracy of empiric antibiotics  Reduce inappropriate use of antibiotics  Narrow down antibiotics after culture results  Avoid unnecessarily long treatments

Each patient deserves inividual consideration Accuracy in antibiotic choice can be improved with education & training. Messages:

No support for antibiotic prophylaxis in trauma for more than 24 h Message:

Short prophylaxis for penetrating abdominal trauma. Messages:

No support for more than one dose of antibiotic prophylaxis in elective surgery Leads to secondary infections and nosocomial infections with MR resistant pathogens Messages:

Do not treat airway cultures with CNS Candida Enterococci

Aggressive diagnostics reduce need for antibiotics Treat VAP for 8 d. Longer if Pseudomonas or necrotizing pneumonia Messages:

Antibiotics in the ICU - summary We need to use the antibiotics we have more wisely Early empiric antibiotics in sepsis Improve accuracy of empiric antibiotics Reduce inappropriate use of antibiotics Short prophylaxis Aggressive diagnostic strategy Narrow down antibiotics after culture results Terminate antibiotics when initial suspicion of sepsis was disproved Avoid unnecessarily long treatment duration Avoid compassionate use of antibiotics