Treatment of Anaerobic Sepsis

Initial Management

Administer IV antimicrobials within one hour of recognition of sepsis or septic shock, as recommended by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine 1, 2
Obtain appropriate microbiologic cultures, including at least two sets of blood cultures with both aerobic and anaerobic bottles, before starting antimicrobials, as suggested by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine 3, 4
Perform imaging studies promptly to identify potential sources of infection requiring source control, according to the Society of Critical Care Medicine 3

Use broad-spectrum antimicrobials covering all likely pathogens, including anaerobes, as recommended by the European Society of Intensive Care Medicine 2, 5
Common regimens include a carbapenem, which provides both gram-negative and anaerobic coverage, as suggested by the European Society of Intensive Care Medicine 5

Identify the specific anatomic source of infection requiring source control as rapidly as possible, and implement source control measures within 12 hours of diagnosis when feasible, as recommended by the European Society of Intensive Care Medicine 5

The typical duration of therapy for anaerobic infections is 7-10 days, but longer courses may be necessary for patients with slow clinical response, as suggested by the European Society of Intensive Care Medicine 2, 6
Reassess antimicrobial regimen daily for potential de-escalation, and narrow therapy once pathogen identification and sensitivities are established and/or clinical improvement is noted, as recommended by the European Society of Intensive Care Medicine 2, 5

Assess clinical response daily, including vital signs, laboratory parameters, and resolution of symptoms, as suggested by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine 7, 8
Target mean arterial pressure of at least 65 mmHg in patients with septic shock requiring vasopressors, and consider guiding resuscitation to normalize lactate in patients with elevated levels, as recommended by the European Society of Intensive Care Medicine 6, 8, 9

Delaying antimicrobial therapy beyond one hour from recognition of sepsis, as warned by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine 1, 2
Failing to obtain appropriate cultures before starting antimicrobials, as cautioned by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine 3, 4
Neglecting source control when indicated, as warned by the European Society of Intensive Care Medicine 5
Continuing broad-spectrum therapy unnecessarily after pathogen identification, as cautioned by the European Society of Intensive Care Medicine 2, 5