commonly used drug combination. Recent CCM literature
suggests that this combination, however, may result in higher
incidence of AKI. Again, therapeutic choice should be
individualized to the institution and the patient, carefully weighing
risks and benefits of each therapy.
Immunosuppressed patients may need possible double antibiotic
coverage for Gram negative organisms, as well as antifungal
agents and appropriate anti-MRSA therapy. If toxic shock
syndromes are a
possibility, addition of Clindamycin is strongly recommended by the
ACCCM, particularly in the pediatric patients.
Once the organism data are available, therapy should be
deescalated and tailored, based on susceptibilities, to minimize risk
of resistant organisms.
As surgical septic patients often have infections that require an
operation, source control involves early surgical intervention
whenever appropriate. This may involve drainage of abscess,
placement of peritoneal drain or laparotomy for NEC, damage
control laparotomy for perforated viscus or intestinal ischemia,