Antibiotic Therapy for Sepsis from a Kidney Stone

Initial Management

Administer IV antimicrobials within one hour of recognition of sepsis or septic shock to reduce morbidity and mortality in patients with sepsis from a kidney stone, as recommended by the Intensive Care Medicine society 1, 3
Obtain appropriate cultures (at least two sets of blood cultures) before starting antibiotics if this does not significantly delay administration (>45 minutes) in patients with suspected sepsis from a kidney stone, according to the Intensive Care Medicine society 3
Initial empiric therapy should cover all likely pathogens, particularly gram-negative organisms which are common in urinary tract infections, as stated by the Critical Care Medicine society 2

The Intensive Care Medicine society recommends extended-spectrum β-lactam (such as piperacillin-tazobactam) as first-line therapy for sepsis from a kidney stone, with a recommended dose of 4.5g IV every 6 hours 1
The Intensive Care Medicine society suggests adding an aminoglycoside (such as gentamicin) or fluoroquinolone (such as ciprofloxacin or levofloxacin) to the extended-spectrum β-lactam for combination therapy in septic shock, with a recommended dose of gentamicin 5-7 mg/kg daily for preserved renal function 4, 5

The Intensive Care Medicine society recommends optimizing dosing based on pharmacokinetic/pharmacodynamic principles for critically ill patients with sepsis from a kidney stone, with consideration of extended infusion over several hours to increase time above MIC 4, 6
The Critical Care Medicine society suggests considering extended infusion of β-lactams over several hours to increase time above MIC in patients with sepsis from a kidney stone 7

The Intensive Care Medicine society recommends continuing combination therapy for no more than 3-5 days in patients with sepsis from a kidney stone, with de-escalation to targeted therapy once culture and sensitivity results are available 1, 6
The Intensive Care Medicine society suggests assessing daily for opportunities to de-escalate antimicrobial therapy in patients with sepsis from a kidney stone 6

The Intensive Care Medicine and Critical Care Medicine societies recommend avoiding delay in administering antibiotics while waiting for cultures, as immediate administration is critical for survival in patients with sepsis from a kidney stone 1, 2
The Intensive Care Medicine society suggests avoiding inadequate doses in critically ill patients with sepsis from a kidney stone, with consideration of higher doses due to increased volume of distribution 4, 5
The Intensive Care Medicine society recommends avoiding failure to consider source control, as antibiotics alone are insufficient without relieving obstruction in patients with sepsis from a kidney stone 6
The Intensive Care Medicine and Critical Care Medicine societies suggest avoiding continuing broad-spectrum combination therapy too long, with de-escalation once culture results are available in patients with sepsis from a kidney stone 1, 7