![]() In most cases, antibiotic treatment should continue for seven to 14 days and should always be administered parenterally. There is no optimal duration of treatment. When the practitioner obtains the final cultures, antibiotics should be titrated to directed therapy starting with the gram stain, and eventually, antimicrobial susceptibility. Additionally, vancomycin should be added to cover resistant gram-positive organisms, most notably methicillin-resistant resistant Staphylococcus aureus (MRSA). Pseudomonas coverage is applicable for hospital-acquired bacteremia, as well as in a patient with recent health care exposure. For example, is the infection community or hospital-acquired, what is the patient's recent healthcare exposure, recent medical or surgical treatment, and what is the local antibiotic resistance? Before a Gram stain is finalized, all patients should receive broad-spectrum antibiotics covering gram-positive and gram-negative bacteria, which include extended-generation cephalosporins or a beta-lactamase inhibitor. ![]() Empiric antibiotics should follow a logical approach based on the patient's history and current disposition. Delay in the administration of appropriate antibiotics is associated with increased morbidity and mortality. Ä«acteremia requires urgent and appropriate antibiotics. Additionally, events can precipitate defense breakdown via trauma, burns, ulcers, and the natural elements of aging. Conditions that interfere with these natural defense barriers commonly include medical procedures that pass through the skin and anatomical lumina. The first barrier to bacterial invasion is the skin and mucosal surfaces. If the bacteria are viable and enter the circulating bloodstream, the infection still may spontaneously clear or progress to septicemia. At this point, the bacteria may become transient and clinically insignificant or can escape the host immune response and increase in number and become a local infection that can eventually migrate to other parts of the body. In its most basic form, bacteria will begin to colonize at its primary source of location. ![]() Cellular innate and adaptive immune responses are responsible for initial microbe clearance, while the liver and spleen filter active bacteria in the circulating blood. All bacterial infections are dependent on the host immune system, which is affected by their genetic signature, as well as congenital and acquired deficiencies.
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