Intensive care medicine recent articles, Dec'08

I have read these two articles and feel that they carry reasonable daily practice importance.

Review - a must read article: Renal replacement therapies: physiological review

Intensive Care Med (2008) 34:2139–2146

Maximizing rates of empiric appropriate

antibiotic therapy with minimized use

of broad-spectrum agents: are surveillance

cultures the key? Intensive Care Med (2008) 34:2130–2133

DOI 10.1007/s00134-008-1249-7

(This is just a summary of the article)E

EDITORIAL

Of the many therapeutic decisions, physicians have to face

in daily ICU practice choosing initial antibiotic therapy in

the patient with suspected severe nosocomial sepsis is one

of the more challenging.

In patients at risk for infection with multidrug

resistant (MDR) pathogens, the clinician has to resort to

broad-spectrum antimicrobials, which are themselves

linked with the emergence of multidrug resistance.

In this respect,appropriate empirical antibiotic therapy should

have a balanced antimicrobial spectrum that includes the

susceptibility of the infectious pathogen, but does not add

unnecessary selection pressure.

As an alternative to empirical combination antibiotic

therapy, a more focused initial antibiotic selection guided

by surveillance cultures (SC) has been reported.

As more reports solidify the clinical usefulness

of SC, cost remains probably the most important factor

prohibiting a general use of systematic SC.

ICUs with a high prevalence of MDR will

benefit the most, as will be patient populations with a high

risk for MDR infection, such as patients with a complex

history, a prolonged hospital stay and numerous previous

antibiotics. To reduce the cost one can consider restricting

surveillance to this ‘difficult’ patient category.