Inflammation and the host response to injury, a large-scale collaborative project

patient-oriented research core--standard operating procedures for clinical care VII--Guidelines for antibiotic administration in severely injured patients.

Michael A. West, Ernest E. Moore, Michael B. Shapiro, Avery B. Nathens, Joseph Cuschieri, Jeffrey L. Johnson, Brian G. Harbrecht, Joseph P. Minei, Paul E. Bankey, Ronald V. Maier

Research output: Contribution to journalArticle

Abstract

When the clinical decision to treat a critically ill patient with antibiotics has been made, one must attempt to identify the site of infection based on clinical signs and symptoms, laboratory or diagnostic radiology studies. Identification of site requires, examination of patient, inspection of all wounds, chest radiograph, and calculation of clinical pulmonary infection score if ventilated, obtaining blood cultures, urinalysis, and line change if clinical suspicion of central venous catheter (CVC) source. If it is impossible to identify site, obtain cultures from all accessible suspected sites and initiate empiric, broad spectrum antibiotics. If likely site can be identified answer these questions: Is intra-abdominal site suspected? Is pulmonary source of infection suspected? Is skin, skin structure or soft tissue site suspected? If yes, does the patient have clinical signs suspicion for necrotizing soft tissue infection (NSTI)? Is a CVC infection suspected? Risk factors for more complicated infections are discussed and specific antibiotic recommendations are provided for each type and severity of clinical infection. Decision to continue, discontinue and/or alter antibiotic/antimicrobial treatment should be based on the clinical response to treatment, diagnostic or interventional findings, and culture and sensitivity data, bearing in mind that not all patients with infections will have positive cultures because of limitations of specimen handling, microbiology laboratory variations, time between specimen acquisition and culture, or presence of effective antibiotics at the time that specimens were obtained. It should also be noted that not all patients with increased temperature/WBC have an infection. Discontinuation of antibiotics is appropriate if cultures and other diagnostic studies are negative.

Original languageEnglish (US)
Pages (from-to)1511-1519
Number of pages9
JournalThe Journal of trauma
Volume65
Issue number6
StatePublished - Dec 2008

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Guidelines
Anti-Bacterial Agents
Inflammation
Wounds and Injuries
Infection
Research
Central Venous Catheters
Specimen Handling
Lung
Skin
Soft Tissue Infections
Urinalysis
Microbiology
Radiology
Critical Illness
Signs and Symptoms
Thorax
Temperature
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Inflammation and the host response to injury, a large-scale collaborative project : patient-oriented research core--standard operating procedures for clinical care VII--Guidelines for antibiotic administration in severely injured patients. / West, Michael A.; Moore, Ernest E.; Shapiro, Michael B.; Nathens, Avery B.; Cuschieri, Joseph; Johnson, Jeffrey L.; Harbrecht, Brian G.; Minei, Joseph P.; Bankey, Paul E.; Maier, Ronald V.

In: The Journal of trauma, Vol. 65, No. 6, 12.2008, p. 1511-1519.

Research output: Contribution to journalArticle

West, Michael A. ; Moore, Ernest E. ; Shapiro, Michael B. ; Nathens, Avery B. ; Cuschieri, Joseph ; Johnson, Jeffrey L. ; Harbrecht, Brian G. ; Minei, Joseph P. ; Bankey, Paul E. ; Maier, Ronald V. / Inflammation and the host response to injury, a large-scale collaborative project : patient-oriented research core--standard operating procedures for clinical care VII--Guidelines for antibiotic administration in severely injured patients. In: The Journal of trauma. 2008 ; Vol. 65, No. 6. pp. 1511-1519.
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