Antibiotic Use for Sepsis in Critical Care: Steve McGloughlin
Antibiotic Use for Sepsis in Critical Care: Steve McGloughlin Steve McGloughlin presents his thoughts on antibiotics and their use in sepsis and critical care. Steve discusses the ABC of sepsis… the trouble is after A for Antibiotics there is not a whole lot else! In sepsis and severe infection, the goal is to change the trajectory of the patient, away from death and to a more favourable outcome. The tools that are currently on offer in critical care are pretty simple. There are things to support the patient such as fluid and ventilators. In addition, we consider goal directed therapy. In terms of definitive therapy, the list is quite small. Perhaps only antibiotics and source control can be turned to. Antibiotics are a powerful tool. So much so that the number needed to treat is around four. They are also very commonly used. 70-80% of patients in the ICU will get antibiotics – far higher than nearly all other treatments. Steve has some basic advice for the use of antibiotics to enhance their effectiveness. Go early as possible when prescribing and administering. In saying that, he cautions to move beyond simple antibiotic prescribing regimes. Whilst we need early antibiotics, we need the right antibiotics. Why? Alexander Fleming warned against drug resistant bugs when developing penicillin. There has been reports of pandrug resistant organisms (bug against which no known drug is effective) in multiple countries and 214 000 neonatal sepsis deaths per year are attributed to resistant pathogens. Steve concludes with a discussion on what more we need when considering sepsis. We need more than antibiotics. As it stands one definition covers all categories of sepsis. The result is a homogenous treatment protocol. In reality, the source, the bug and the pathology all change the disease and all call for an individualised treatment regime. That is the future. For more like this, head to our podcast page. #CodaPodcast
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Antibiotic Use for Sepsis in Critical Care: Steve McGloughlin
- 1. A is for Antibiotics After that we are STUCK Steve McGloughlin The Alfred
- 4. SEPSIS
- 5. Sepsis is
- 13. Severe Infection
- 15. Intensivists
- 16. Intensivists
- 17. Intensivists
- 20. Severe Infection ? Support Antibiotics Source Control We need something else!
- 21. Sepsis is
- 22. What do we have….
- 25. NNT
- 27. Why Not?
- 28. Sick Very Sick Which Antibiotic? I want you to be honest?
- 30. The thoughtless person playing with penicillin treatment is morally responsible for the death of the person who succumbs to infection with the penicillin resistant organism.
- 32. 214000 neonatal sepsis deaths attributable to resistant pathogens
- 33. Figure 1: Estimated pneumonia deaths avertable in under-5 populations with improved antibiotic access Countries with less than 100 deaths averted are not labelled. Data on under-5 population with suspected pneumonia receiving antibiotics are from 1990 to 2013; data from the most recent year reported is used, when available. 0 20 40 60 80 Trendline weighted by the under-5 population of each country 100 0 1 2 3 4 5 6 Pneumoniadeaths(duetoStreptococcuspneumoniaeandHaemophilus influenzaetypeb)per1000childrenagedyoungerthan5years Under-5 population with suspected pneumonia receiving antibiotics (%) India Nigeria DR Congo Pakistan China Ethiopia Afghanistan Sudan Indonesia Somalia Mali Niger Uganda Chad Tanzania Burkina Faso Kenya Yemen Mozambique Cameroon Myanmar Philippines Côte d’Ivoire Bangladesh Guinea Iraq Madagascar Nepal Malawi Ghana Burundi Benin Sierra Leone Uzbekistan Zambia Egypt Haiti Senegal Iran Central African Republic Togo Vietnam Morocco Brazil Rwanda Zimbabwe Mauritania Cambodia Tajikistan Algeria Congo (Brazzaville) Guinea−Bissau Bolivia ColombiaTurkey Thailand North KoreaLaos Argentina KazakhstanPeru Timor−Leste Dominican Republic Equatorial Guinea Kyrgyzstan Syria Gambia Comoros Swaziland Honduras Paraguay Ukraine India (169760) Nigeria (49407) Nepal (2434) Hypothetical under-5 pneumonia deaths averted with universal antibiotic access 1 million Avoidable deaths in 2013 in under 5’s from pneumonia 170 000 deaths in India avoidable with Antibiotics
- 37. A disease caused by an uncontrolled division of abnormal cells in a part of the body. Life-threatening organ dysfunction due to a dysregulated host response to infection Cancer is Sepsis is
- 38. One definition?
- 39. f not recognized early and treated promptly Heart Brain Lung Infection Liver Kidney From a lo general i A local infect comes the bo Pathogenic g produce leave infection and Stage1 The source changes the risk of death
- 40. MULTIDRUG-RESISTANT PSEUDOMONAS AERUG 6,700 44MULTIDRUG-RESISTANT PSEUDOMONAS INFECTIONS DEATH THREAT LEVEL SERIOUS This bacteria is a serious concern and requires prompt and sustained action to ensure the problem does not grow. 51,000 PSEUDOMONAS INFECTIONS PER YEAR MET STA (MR THREAT LEVEL SERIOUS This bacteria is a serious concern and requires prompt and sustained action to ensure the problem does not grow. Methicillin-resistant Staphylococcus aureus (MRSA) causes a range of illnesses, from skin and wound infections to pneumonia and bloodstream infections that can cause sepsis and death. Staph bacteria, including MRSA, are one of the most common causes of healthcare-associated infections. The bugs are not the same…
- 41. Pathology is not the same
- 42. The Narrow Spectrum Era……. 1925 1950 1975 2000 2025 Golden Era Nature products Medicinal Chemistry Era Synthetic tweaking Resistance era Target based, broad spectrum Narrow-Spectrum era Unconventional Combination approaches Diagnostic development 1925 1975 2000 2025 1950
- 43. The Narrow Spectrum Era……. 1925 1950 1975 2000 2025 Golden Era Nature products Medicinal Chemistry Era Synthetic tweaking Resistance era Target based, broad spectrum Narrow-Spectrum era Unconventional Combination approaches Diagnostic development 1925 1975 2000 2025 1950
- 46. Sepsis is
- 47. If ICU and ED want to own sepsis…..
- 48. In memory of my sister Bec
- 49. Most people spend their time and energy going around problems rather than in trying to solve them. Henry Ford