Starting antibiotics within the first hour after sepsis saves lives.









Antibiotic resistance, which has increased in the world after the pandemic, is leading to much deadlier outcomes in intensive care units. Being able to start infection treatment as soon as possible in intensive care patients, who are the most critical patients in the fight against drug-resistant infections, forms the thin line between death and life. Even failure to start the correct antibiotics within the first hour when an infection occurs in a patient in intensive care decreases treatment success and may result in the patient receiving antibiotics for a longer period of time; This paves the way for antibiotic resistance. In addition, the longer the treatment period, the greater the risk of opportunistic fungal infections. In this way, the process can end up in a vicious circle. Chairman Turkish Intensive Care Association Prof. dr. Dr Oktay Demirkıran said intensive care specialists should be allowed to prescribe antibiotics as soon as possible. Noting that the intensive care units, which faced a very high patient load during the pandemic period, experienced a different intensity during the earthquake, Prof. Dr. Demirkıran gave important information about the latest situation in intensive care units and antibiotic resistance, one of the most dangerous situations for patients.

“IN THE EARTHQUAKE, THE INTENSIVE CARE WAS DEFECTIVE FOR A TIME”

Prof. Dr. Demirkıran said that the differentiation process in intensive care units, which started with the pandemic, continued with the earthquake: “The most negative aspect of the earthquake disaster in the intensive care units was that some hospitals were unfortunately unusable and demolished.” The patients with crush syndrome had to be taken to more distant provinces. Now we are slowly coming back to ourselves. Intensive care units in places where earthquake disasters have occurred have regained their old activations,” he said.

“WE HAVE ENCOUNTERED INFECTION VERY OFTEN”

prof. Dr. Demirkıran gave the following information: “Because these patients often had to undergo some kind of surgical procedure, which we call debridement, fasciotomy, due to bruising injuries. These patients were taken to the operating room daily for these procedures, their legs or arms were opened, and after being intervened again, they were sent back to the intensive care unit. Every intervention, procedure means an open door to a new infection. Therefore, infection also emerged as a serious problem during this period. Our intensive care workers during the earthquake region , who went through this intensely, really tried to fight the infection and let the patients survive. They really put a lot of effort into keeping it.”

“ANTIBIOTICAL RESISTANCE IS A BIG DANGER”

Noting that antibiotic resistance is a very serious problem that is increasing both in our country and in the rest of the world, Prof. Dr. Demirkıran continued his words as follows: “The widespread use of antibiotics in such a large number and variety has led to the emergence of more resistant microorganisms and the formation of resistant strains. During the pandemic period, immunosuppressants were used very widely and this facilitated infections in these patients. Again, the immune system was suppressed. “This situation can easily occur in patients with elderly patients and diabetic patients. Rational use of antibiotics is therefore vital.”

“INTENSIVE CARE SPECIALISTS MUST ALSO GIVE THE RIGHT TO WRITE ANTIBIOTICS”

Emphasizing that rational use of antibiotics involves not only giving the most appropriate antibiotic for the infection, but also starting the treatment on time, explains Prof. Dr. Demirkıran said: “The main problem here is that there is a situation that prevents long-term use of antibiotics: the faster you can fight the infection, the shorter you will use antibiotics. This is one of the most important things we try to draw attention to. Considering that the mortality rate of the intensive care specialists serving in intensive care and the doctors responsible for intensive care, especially in the case of sepsis, starting antibiotic treatment within the first hour, as the literature states , will decrease the mortality rate, it has been emphasized that the right to use and prescribe antibiotics must also be in intensive care units. We’re standing strong and we’re still trying to get this right,” he said.

“INFECTION IS NOT THE FATE OF THE INTENSIVE CARE PATIENT”

prof. Demirkıran ended his words as follows: “So this cannot be normalized. That is why we must start antibiotic treatment in time and be able to get the infection under control. In current practice, antibiotics can be used with the consent of an infectious disease specialist. This is, of course, a situation that is easily realized in large hospitals in large cities. However, in places where the infectious disease specialist is not always available, in cases after midnight, in cases where antibiotic treatment must be started in the first hour in an emergency, the time to obtain this authorization may be longer. Unfortunately, the disease can become more serious. That is why I strongly emphasize that intensive care workers must also have the right to prescribe antibiotics. If there is an infection at the beginning of antibiotic therapy, antibiotics that can treat this infection are immediately started, which we call empirical, and suitable cultures are taken from the patient just before treatment, and it is determined which microorganism grows according to the results of this within 2-3 days. According to him, the antibiotic that is effective against that microbe is revealed and the treatment is shaped. Antibiotics can be reduced, stopped altogether, or continued. In this way, resistance to antibiotics can be reduced and patients can be treated successfully.


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