eMedicineLive

Early and appropriate antibiotic therapy is one of the cornerstones of sepsis management. In a study conducted in a large academic center it was found that nearly one third of the patients received inappropriate antibiotic therapy initially. The inappropriate therapy includes situations where the antibiotic was administered later than 24 hours from the onset of sepsis and using antibiotic for which the organism is resistant. The study showed that the delay in starting the antibiotic was responsible for 58% of inappropriate antibiotic therapy. Previous studies have shown that in a patient with sepsis each one hour delay in administering sensitive antibiotic was associated with greater than 10% increase in probability of death. Similarly in disseminated fungal infections, delays in antifungal therapy increases the risk of mortality two fold.

The author recommends broad spectrum antibiotic therapy early in the course of sepsis. Though high end broad spectrum antibiotics are costlier, their use may reduce the length of stay and lower the overall costs of hospitalization. Also earlier discharge from the ICU results in lesser risk for hospital acquired infections and venous thromboembolism. One of the concerns of using broader spectrum of antibiotics is emergence of resistance. The author advices to use broad spectrum antibiotic initially and deescalate the therapy once the infecting organism and its sensitivity pattern to antibiotics is known.

Reference
http://journals.lww.com/ccmjournal/Fulltext/2011/01000/Inappropriate_antibiotic_therapy_in_Gram_negative.8.aspx