VIDEO: Considerations for appropriate antimicrobial stewardship in patients with sepsis

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Antimicrobial stewardship is very important in patients with sepsis or those with possible sepsis. There's been a lot of attention paid in recent decades to helping hospitals and clinicians rapidly give broad-spectrum antibiotics to patients with possible sepsis, which I think in general is understandable and benefits a lot of patients.

But perhaps not surprisingly, there's increasing evidence that this is contributing to antibiotic overuse and resistance since a lot of patients with possible sepsis end up having noninfectious diagnoses in retrospect, or they have bugs that are susceptible to routine antibiotics, or they have viruses that don't require antibiotics at all.

But I'll say that while most people think about trying to avoid unnecessary broad-spectrum antibiotics when you say antibiotic stewardship, stewardship actually involves a lot more than that, including ensuring that the patient receives the right drug for the responsible pathogen or the suspected pathogen, obtaining appropriate diagnostic tests before giving antibiotics to facilitate subsequent de-escalation and tailoring of antibiotics, optimizing antibiotic dosing, de-escalating antibiotics in a timely fashion when you have isolated a pathogen or you have negative microbiological cultures and choosing an appropriate duration of therapy.

Over the past 2 decades, every time it's been studied, generally evidence shows that we can successfully treat most infections with much shorter antibiotic courses that have been commonly used in the past. So all of these aspects cannot only help prevent antibiotic resistance but also give patients the best chance of having a good outcome.