Considerations for Empiric Antimicrobial Therapy in Sepsis and Septic Shock in an Era of Antimicrobial Resistance

J Infect Dis. 2020 Jul 21;222(Suppl 2):S119-S131. doi: 10.1093/infdis/jiaa221.

Abstract

Patients with sepsis present across a spectrum of infection sites and severity of illnesses requiring complex decision making at the bedside as to when prompt antibiotics are indicated and which regimen is warranted. Many hemodynamically stable patients with sepsis and low acuity of illness may benefit from further work up before initiating therapy, whereas patients with septic shock warrant emergent broad-spectrum antibiotics. The precise empiric regimen is determined by assessing patient and epidemiological risk factors, likely source of infection based on presenting signs and symptoms, and severity of illness. Hospitals should implement quality improvement measures to aid in the rapid and accurate diagnosis of septic patients and to ensure antibiotics are given to patients in an expedited fashion after antibiotic order.

Keywords: antimicrobial resistance; empiric antibiotics; sepsis; septic shock.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / adverse effects
  • Anti-Bacterial Agents* / therapeutic use
  • Antimicrobial Stewardship
  • Drug Resistance, Bacterial*
  • Empirical Research
  • Humans
  • Inappropriate Prescribing
  • Sepsis / drug therapy*
  • Shock, Septic / drug therapy

Substances

  • Anti-Bacterial Agents