Empirical Treatment of Sepsis in Geriatric Patients

Introduction to Sepsis Treatment

The European Society of Intensive Care Medicine recommends that empirical antibiotic therapy in geriatric patients with sepsis should be started as soon as possible, within the first hour of sepsis recognition, using broad-spectrum antibiotics that cover all likely pathogens 1, 2
The Society of Critical Care Medicine suggests that intravenous antibiotics should be administered within one hour of sepsis or septic shock recognition 1, 3

The Infectious Diseases Society of America recommends that appropriate microbiological cultures, including at least two sets of blood cultures, should be obtained before starting antibiotic therapy, if this does not cause a significant delay in the start of antibiotic treatment 4, 5
The European Society of Clinical Microbiology and Infectious Diseases states that empirical therapy should include one or more broad-spectrum antibiotics active against all likely bacterial and potentially fungal or viral pathogens 6, 2

For patients with septic shock, the Surviving Sepsis Campaign recommends combined therapy using at least two antibiotics from different classes, targeting the most likely bacterial pathogens 2, 3
For infections associated with respiratory failure and septic shock, the American Thoracic Society recommends a combination of a broad-spectrum beta-lactam and an aminoglycoside or fluoroquinolone when Pseudomonas aeruginosa is suspected 5, 7
For septic shock caused by Streptococcus pneumoniae bacteremia, the Infectious Diseases Society of America recommends a combination of a beta-lactam and a macrolide 7, 8

The Society of Critical Care Medicine recommends that empirical combined therapy should not be used for more than 3-5 days 7, 2
The European Society of Intensive Care Medicine suggests that de-escalation with discontinuation of combined therapy should occur within the first few days in response to clinical improvement and/or confirmation of infection resolution 3, 8
Antibiotic therapy should be narrowed after pathogen identification, susceptibility determination, and/or adequate clinical improvement 2, 3
Typical treatment duration is 7-10 days; longer courses may be necessary for patients with slow clinical response, undrainable infection sites, bacteremia due to Staphylococcus aureus, and certain fungal and viral infections 7, 8

The Infectious Diseases Society of America recommends optimizing antibiotic dosing strategies based on accepted pharmacokinetic/pharmacodynamic principles and specific drug properties in patients with sepsis or septic shock 2, 5
The antimicrobial regimen should be reviewed daily for possible de-escalation 7, 3
Low levels of procalcitonin or similar biomarkers may help clinicians stop empirical antibiotic therapy in patients initially suspected of having sepsis but later found to have no evidence of infection 7, 2