tailieunhanh - Báo cáo y học: "Diagnosing sepsis: does the microbiology matter"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Diagnosing sepsis: does the microbiology matter? | Available online http content 12 3 145 Commentary Diagnosing sepsis does the microbiology matter Jonathan Cohen Division of Clinical Medicine Brighton Sussex Medical School Brighton Falmer BN1 9PX UK Corresponding author Jonathan Cohen Published 6 May 2008 This article is online at http content 12 3 145 2008 BioMed Central Ltd Critical Care 2008 12 145 doi cc6881 See related review by Gao et al. http content 12 3 212 Abstract Sepsis is caused by infection and knowing what type of organism is causing the infection certainly matters in terms of both epidemiology and selecting antibiotic therapy. Although there is considerable laboratory evidence that micro-organisms initiate sepsis in different ways the clinical consequences are usually indistinguishable. New drugs that target specific points in the activation pathway are starting to emerge and these will require us to be much more accurate in how we diagnose sepsis. Given the time and attention devoted to sepsis in most intensive care units and the amount of antibiotics that are prescribed for what is by common consent a disease caused by micro-organisms the title of the paper by Gao and coworkers 1 in this issue of Critical Care might seem a little curious. Knowing whether the infecting organism is Streptococcus pneumoniae or Escherichia coli quite clearly matters when it comes to prescribing antibiotics. It is intuitively the case that patients who are treated with antibiotics that are effective against the causative organism are more likely to do well than if they are treated with an ineffective agent - an impression confirmed by a number of observational studies 2 3 . Indeed a recent paper 4 went further and demonstrated that it was not only the choice of antibiotics but also the speed with which they were given that was crucial delaying the start of treatment even by as little as 1 hour increases the chance of a poor outcome. Identifying the .