The 2021 Dutch Working Party on Antibiotic Policy (SWAB) guidelines for empirical antibacterial therapy of sepsis in adults.

Adult Anti-Bacterial Agents / therapeutic use Humans Netherlands Policy Sepsis / drug therapy
Antibacterial therapy Antimicrobial resistance Duration of antibiotic therapy Empirical therapy Enterobacterales Guidelines Penicillin allergy Pharmacodynamics Pharmacokinetics Pseudomonas aeruginosa Sepsis

Journal

BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551

Informations de publication

Date de publication:
11 Aug 2022
Historique:
received: 08 04 2022
accepted: 25 07 2022
entrez: 11 8 2022
pubmed: 12 8 2022
medline: 16 8 2022
Statut: epublish

Résumé

The Dutch Working Party on Antibiotic Policy (SWAB) in collaboration with relevant professional societies, has updated their evidence-based guidelines on empiric antibacterial therapy of sepsis in adults. Our multidisciplinary guideline committee generated ten population, intervention, comparison, and outcome (PICO) questions relevant for adult patients with sepsis. For each question, a literature search was performed to obtain the best available evidence and assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The quality of evidence for clinically relevant outcomes was graded from high to very low. In structured consensus meetings, the committee formulated recommendations as strong or weak. When evidence could not be obtained, recommendations were provided based on expert opinion and experience (good practice statements). Fifty-five recommendations on the antibacterial therapy of sepsis were generated. Recommendations on empiric antibacterial therapy choices were differentiated for sepsis according to the source of infection, the potential causative pathogen and its resistance pattern. One important revision was the distinction between low, increased and high risk of infection with Enterobacterales resistant to third generation cephalosporins (3GRC-E) to guide the choice of empirical therapy. Other new topics included empirical antibacterial therapy in patients with a reported penicillin allergy and the role of pharmacokinetics and pharmacodynamics to guide dosing in sepsis. We also established recommendations on timing and duration of antibacterial treatment. Our multidisciplinary committee formulated evidence-based recommendations for the empiric antibacterial therapy of adults with sepsis in The Netherlands.

Sections du résumé

BACKGROUND BACKGROUND
The Dutch Working Party on Antibiotic Policy (SWAB) in collaboration with relevant professional societies, has updated their evidence-based guidelines on empiric antibacterial therapy of sepsis in adults.
METHODS METHODS
Our multidisciplinary guideline committee generated ten population, intervention, comparison, and outcome (PICO) questions relevant for adult patients with sepsis. For each question, a literature search was performed to obtain the best available evidence and assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The quality of evidence for clinically relevant outcomes was graded from high to very low. In structured consensus meetings, the committee formulated recommendations as strong or weak. When evidence could not be obtained, recommendations were provided based on expert opinion and experience (good practice statements).
RESULTS RESULTS
Fifty-five recommendations on the antibacterial therapy of sepsis were generated. Recommendations on empiric antibacterial therapy choices were differentiated for sepsis according to the source of infection, the potential causative pathogen and its resistance pattern. One important revision was the distinction between low, increased and high risk of infection with Enterobacterales resistant to third generation cephalosporins (3GRC-E) to guide the choice of empirical therapy. Other new topics included empirical antibacterial therapy in patients with a reported penicillin allergy and the role of pharmacokinetics and pharmacodynamics to guide dosing in sepsis. We also established recommendations on timing and duration of antibacterial treatment.
CONCLUSIONS CONCLUSIONS
Our multidisciplinary committee formulated evidence-based recommendations for the empiric antibacterial therapy of adults with sepsis in The Netherlands.

Identifiants

DOI: 10.1186/s12879-022-07653-3 PMID: 35953772 PMC: PMC9373543
pubmed: 35953772
doi: 10.1186/s12879-022-07653-3
pii: 10.1186/s12879-022-07653-3
pmc: PMC9373543
doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

687

Informations de copyright

© 2022. The Author(s).

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Auteurs

Elske Sieswerda (E)

Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands. e.sieswerda@umcutrecht.nl.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. e.sieswerda@umcutrecht.nl.

Hannelore I Bax (HI)

Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.

Jacobien J Hoogerwerf (JJ)

Department of Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.

Mark G J de Boer (MGJ)

Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.

Marja Boermeester (M)

Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Marc J M Bonten (MJM)

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Douwe Dekker (D)

Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.

Roy Gerth van Wijk (RG)

Division of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.

Nicole P Juffermans (NP)

Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands.

Marnix Kuindersma (M)

Department of Intensive Care, Gelre ziekenhuis Apeldoorn, Apeldoorn, The Netherlands.

Paul D van der Linden (PD)

Department of Clinical Pharmacy, Tergooi Hospital, Hilversum, The Netherlands.

Damian C Melles (DC)

Department of Medical Microbiology and Immunology, Meander Medical Center, Amersfoort, The Netherlands.

Peter Pickkers (P)

Department of Intensive Care Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.

Jeroen A Schouten (JA)

Department of Intensive Care Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.

Jasper R Rebel (JR)

Department of Emergency Medicine, OLVG Hospital, Amsterdam, The Netherlands.

Arthur R H van Zanten (ARH)

Department of Intensive Care Medicine, Ziekenhuis Gelderse Vallei, Ede, The Netherlands.

Jan M Prins (JM)

Division of Infectious Diseases, Department of Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

W Joost Wiersinga (WJ)

Division of Infectious Diseases, Department of Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

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