Timsit et al reviewed appropriate antibiotic use for an intensive care unit patient with the new onset of a suspected infection. The authors are from Universite de Paris Sorbonne, Royal Brisbane and Women's Hospital (Brisbane), the University of Queensland, University of Montpellier and the University of Genoa.
Patient selection: ICU patient with new onset of a suspected infection
Indications to start antimicrobial therapy:
(1) positive rapid test for an organism in a suspected infection site
(2) organ failure or increased need for vasopressor agents
(3) positive blood or other culture
If none of the indications are present, then look for other causes that can explain the observed findings.
If any of the indications are present, then select antimicrobial therapy based on available data.
If the patient has a condition that affects drug clearance (renal failure, renal replacement therapy, etc) then adjust antimicrobial therapy to optimize coverage.
As more data becomes available then adjust therapy to narrow the spectrum, favoring monotherapy when possible.
If the patient does not respond to therapy, then re-evaluate the patient and either adjust or change therapy.
If the patient has responded to therapy, then consider early discontinuation based on recommendations and clinical status.
