Antibiotics-sepsis and shock

• Start empiric IV abx as soon as possible after recognition of severe sepsis or septic shock; every hr delay in abx admin a/w 7.6% ↑ in mortality (Crit Care Med 2006;34:1589), abx admin w/in 3 h of presentation in the ED a/w ↓ in-hospital mortality (NEJM 2017;376:2235)

• If possible, 2 sets of BCx before urgently starting abx (but do not delay abx)

• Broad gram-positive (incl MRSA) & gram-neg (incl highly resistant) coverage, ± anaerobes

• Procalcitonin-guided cessation (not initiation) ↓ mortality (Crit Care Med 2018;46:684)

• Empiric micafungin in critically ill Pts w/ Candida colonization & sepsis of unknown etiology ↓ invasive fungal infxns & tended ↑ invasive fungal infxn-free survival, espec. in Pts w/ 1,3-b-D-glucan >80 (JAMA 2016;316:1555)

但一項針對 75 個國家的重症監護病房 (ICU) 14,000 名患者的點流行率研究發現，62% 的陽性分離株是革蘭氏陰性菌，47%是革蘭氏陽性菌，19%是真菌。