Patients with complex medical and surgical issues are often admitted to the intensive care unit (ICU). In such patients, prompt administration of broad spectrum empirical antibiotics is mandatory to control the infection. Antibiotic therapy should be instituted as soon as possible after the relevant culture specimens of blood, urine, endotracheal secretions or cerebrospinal fluid are sent. Ideally, empirical antibiotic therapy should be initiated within the first hour of admission of patients with suspected sepsis in ICU. While selecting the empirical antibiotic therapy, the patient's clinical history along with the probable source of infection, previous antibiotic history and most likely pathogens according to the prevalence in the particular intensive care unit (ICU) should be taken into account. A delay in initiating empirical antibiotic therapy is associated with a higher risk of progression to severe sepsis, more days on ventilator and ultimately an adverse outcome. However, empirical therapy should be de-escalated as soon as the culture and sensitivity reports are available to the clinician.
Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections onpatient outcomes in the ICU setting. Chest 2000;118:146-55.
Leekha S, Terrell CL, Edson RS. General principles of antimicrobial therapy. Mayo Clin Proc 2011; 86:156-67.
Todi S, Chawla R. Antibiotic stewardship. In:Chawla R, Todi S. Editors. ICU Protocols: A stepwise approach. Springer: India. 2012. p. 389-93.
Sarin MSK, Vadivelan M, Bammigatti C. Antimicrobial therapy in the intensive care unit. Indian Journal of Clinical Practice 2013;23:601-9.
Paterson DL, Rice LB. Empirical antibiotic choice for the seriously ill patient: Are minimization of selection of resistant organisms and maximization of individual outcome mutually exclusive? Clinical Infectious Diseases 2003;36:1006-12.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. 2008 Crit Care Med 2008;36:296-327.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock:2012. Crit Care Med 2013;41:580-637.
Munford RS. Severe sepsis and septic shock. In: Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, Loscalzo J. Editors. Harrison's Principles of Internal Medicine. 18thed. New York. The McGraw-Hill Companies(USA); 2012. p. 2223-32.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas NE, Giske CG. Multidrugresistant, extensively drug resistant and pan drug resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-81.
Ahmed A, Azim A, Gurjar M, Baronia AK. Current concepts in combination antibiotic therapy for critically ill patients. Indian Journal of Critical care Medicine 2014;18:310-4.
Gilbert DN, Chambers HF, Eliopoulos GM, Saag MS. Treatment options for systemic infection due to selected multi-drug resistant Gramnegative bacilli. In: Gilbert DN, Chambers HF, Eliopoulos GM, Saag MS. Editors. The Sanford Guide to Antimicrobial Therapy 2015. 45th Edition. Sperryville. Antimicrobial Therapy, Inc. (USA);2015.p.78.
American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospitalacquired, ventilator-associated, and healthcare associated pneumonia. Am J Respir Crit Care Med 2005;171(4):388-416.
Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49(1):1-45.
Timsit JF, Soubirou JF, Voiriot G, Chemam S, Neuville M, Mourviller B et al. Treatment of blood stream infections in ICUs. BMC Infectious Diseases 2014;14:489
Textoris J, Wiramus S, Martin C, Leone M. Overview of antimicrobial therapy in intensive care units. Expert Rev Anti Infect Ther 2011;9(1):97-109.
Sawyer RG, Claridge JA, Nathens AB, Rostein OD, Duane TM, Evans HL. Trial of shortcourse antimicrobial therapy or intraabdominal infection. N Engl J Med 2015;372:1996-2005.
Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJC, Baron EJ et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Disease Society of America. Clinical Infectious Diseases 2010;50:133-64. 18. Tamma PD, Cosgrove SE, Maraqakis LL. Combination therapy for treatment of infections with gram-negative bacteria. Clin Microbiol Rev 2012;25:450-70.