PHRM 211 Lecture Notes - Lecture 14: Septic Shock, Antimicrobial Resistance, Antibiotic Sensitivity
Document Summary
Likely pathogens: risk factors for resistant organisms, early vs late onset. Several studies show increase in mortality with increasing delay to administration of effective antimicrobial therapy in patients with septic shock. Features suggesting high risk of mortality: need for ventilatory support, septic shock. Hospitalization for at least 5 days (late onset) Prior detection of mrsa (on culture or screening) Treatment in unit where prevalence of mrsa amongst s. aureus isolates is >20% Other: ivdu, hemodialysis patients, skin disease, venous catheters, other foreign bodies (pacemakers), surgical procedures, hospitalization. Empiric antimicrobial therapy should be guided by local frequencies of pathogens & their antimicrobial susceptibilities. Antibiograms: list proportion of organisms, isolated in a particular ward/institution, susceptible to antimicrobials over a set time period. Daptomycin sequestered by pulmonary surfactant inactivation of drug. Current knowledge of pk/pd of antimicrobials in lung tissue based on concentration of drug in epithelial lung fluid (elf) Beta-lactams, aminoglycosides, and glycopeptides elf:plasma ratios <1.
