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.