From the Guidelines
The treatment for septic emboli involves aggressive antimicrobial therapy, source control, and supportive care, with empiric broad-spectrum antibiotics started immediately, typically including vancomycin plus either piperacillin-tazobactam, a carbapenem, or cefepime, and continued for 4-6 weeks in most cases, as recommended by the Surviving Sepsis Campaign guidelines 1. The goal of therapy is to cover all likely pathogens, including bacterial and potentially fungal or viral coverage, and to penetrate in adequate concentrations into tissues presumed to be the source of sepsis.
- Key considerations include:
- Administration of effective intravenous antimicrobials within the first hour of recognition of septic shock and severe sepsis without septic shock 1
- Initial empiric anti-infective therapy with one or more drugs that have activity against all likely pathogens 1
- Antimicrobial regimen reassessment daily for potential de-escalation 1
- Use of low procalcitonin levels or similar biomarkers to assist in discontinuing empiric antibiotics in patients who initially appeared septic but have no subsequent evidence of infection 1 Source control is essential and may require surgical intervention, such as valve replacement for endocarditis, drainage of abscesses, or removal of infected catheters or devices.
- Supportive care includes:
- Hemodynamic support
- Respiratory support if needed
- Management of complications like organ dysfunction The extended antibiotic course is necessary because septic emboli represent metastatic infection, where bacteria have traveled through the bloodstream to establish infection at distant sites, requiring prolonged treatment to fully eradicate the infection and prevent recurrence. Anticoagulation is generally not recommended unless there are specific indications like deep vein thrombosis, as stated in the guidelines for the management of intravascular catheter-related infections 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Septicemia Vancomycin Injection is indicated in adults and pediatric patients for whom appropriate dosing with this formulation can be achieved [see Dosage and Administration (2) and Use in Specific Populations (8. 4)] for the treatment of septicemia due to: • Susceptible isolates of methicillin-resistant Staphylococcus aureus (MRSA) and coagulase negative staphylococci.
The treatment for septic emboli is not directly addressed in the provided drug label. However, septicemia is mentioned, which can be related to septic emboli.
- Vancomycin Injection is indicated for the treatment of septicemia due to susceptible isolates of MRSA and coagulase negative staphylococci 2. It is essential to note that septic emboli treatment may involve addressing the underlying cause of the sepsis, which in this case could be treated with Vancomycin Injection if the causative organism is susceptible.
From the Research
Treatment for Septic Emboli
The treatment for septic emboli typically involves the use of antimicrobial agents. The choice of antimicrobial agent depends on the suspected causative organism and local microbial resistance patterns 3.
- For methicillin-resistant Staphylococcus aureus (MRSA) septic pulmonary embolism, daptomycin and linezolid have been shown to be effective salvage therapies 4.
- Daptomycin in combination with rifampin has also been used to treat MRSA septic pulmonary emboli in the absence of endocarditis 5.
- The use of daptomycin for the treatment of Staphylococcus aureus infections complicated by septic pulmonary emboli has been reviewed, and the available evidence suggests that it may be an effective option 6.
- In cases of MRSA sepsis presenting with septic pulmonary emboli, aggressive antibiotic therapy has been shown to be effective in achieving full recovery 7.
Antimicrobial Agent Selection
The selection of antimicrobial agents for the treatment of septic emboli should be based on a combination of patient factors, predicted infecting organism(s), and local microbial resistance patterns 3.
- The initial drugs should have activity against typical gram-positive and gram-negative causative micro-organisms.
- Anaerobic coverage should be provided for intra-abdominal infections or others where anaerobes are significant pathogens.
- Empiric antifungal or antiviral therapy may be warranted in certain cases.