What is the role of antibiotic therapy in the treatment of sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

IV antibiotic therapy should be initiated within the first hour after the recognition of septic shock or sepsis; delays in administration are associated with increased mortality. [5, 11, 60] Selection of antibiotic agents is empiric, based on an assessment of the patient’s underlying host defenses, the potential source of infection, and the most likely responsible organisms. (See Empiric Antimicrobial Therapy.)

When the source is unknown, the antibiotic chosen must be a broad-spectrum agent that covers gram-positive, gram-negative, and anaerobic bacteria. In addition, consideration must be given to pathogens with antibiotic resistance, such as methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas species, and gram-negative organisms with extended-spectrum beta-lactamase (ESBL) activity.

Patients who are at risk for these types of infection are those with recent, prolonged, or multiple hospitalizations. The 2012 Surviving Sepsis Campaign guidelines recommend combination empiric therapy for neutropenic patients as well as for those with difficult-to-treat, multidrug-resistant microorganisms, such as Acinetobacter and Pseudomonas. [11]


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