Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 57: Bugs and Drugs Part 2 With Rachel Kruer
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Oct 5, 2017 Rachel Kruer, a Surgical ICU pharmacist, dives into the complexities of antibiotic therapy for common ICU infections. She discusses selecting empiric antibiotics based on infection site, the importance of narrowing therapy after source control, and how GI flora influences treatment. Rachel also covers managing intra-abdominal infections, pneumonia, and catheter-associated UTIs, emphasizing tailored approaches based on patient risk factors. With practical tips on antibiotic durations and when to switch therapies, this conversation is a must-listen for clinicians in critical care.
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Pick Antibiotics By Source And Severity
- Choose empiric antibiotics based on suspected site and likely pathogens, not just lab MICs.
- Factor severity, community vs hospital acquisition, and tissue penetration when selecting therapy.
Narrow Antibiotics After Source Control
- Narrow antimicrobial therapy once source control exists and susceptibilities are known.
- Stop vancomycin if resistant gram-positive organisms are not recovered to support stewardship.
Anatomic Flora Guide Drug Choice
- GI infections vary by anatomical location and expected flora from oral cavity to colon.
- Use that anatomic microbiology to guide coverage for gram positives, gram negatives, anaerobes, and Candida where appropriate.