Antimicrobial Use in Surgical Intensive Care

Judicious antimicrobial use is essential in modern surgical intensive care. This requires careful clinical assessment and aggressive diagnostics to identify sources of infection as well as their noninfectious mimics. Because antimicrobial agents affect the ecology of resistant organisms in neighboring patients and the wider environment, as well as cause other common adverse effects, restrained initiation of antibiotics may be as valuable among hemodynamically stable patients with possible infection as is urgent empiric coverage in those threatening septic shock. Early collaboration with infectious disease and pharmacy consultants yields more appropriate treatment and improved morbidity, duration of hospital care, costs, and survival.