ABSTRACT
Early empiric antimicrobial therapy is essential in the critical care unit (CCU) because in many cases a specific diagnosis is not possible at the outset. For antimicrobial therapy to be effective, the patient has to have an infectious disease that is amenable to antimicrobial therapy, and the therapy should be administered as soon as possible to achieve maximum therapeutic effect. Antimicrobial therapy should be directed at the most likely pathogens involved in the infectious process, which derive from the flora of the focus of infection. It is obvious that antimicrobial therapy should be administered as soon as possible to critically ill patients to achieve maximum therapeutic benefit. There are many infectious processes that require surgical intervention in addition to appropriate antimicrobial therapy. Surgical intervention is the primary therapeutic intervention when the patient’s infectious disease process is based on the obstruction or perforation of a viscus, an abscess, or infected associated material, i.e., central intravenous (IV) line, shunts, biliary or urethral stents, etc. In all of these situations, antimicrobial therapy is adjunctive, and removal of an infected device, relief of obstruction, correction of perforation, or abscess drainage should not be delayed with the expectation that antimicrobial therapy alone can bring the infection under control (1,2).
