Steve is in the unique position of working both as an intensive care and infectious diseases consultant at The Alfred in Melbourne. His research and quality interests are in both infectious diseases and intensive care, particularly the management of sepsis and antibiotic resistance both locally and on a more global scale with involvement in a number of international collaborations. He was lead author for the Australian Therapeutic Guidelines chapter on sepsis and has published a number of other chapters on infections in intensive care, particularly in immunosuppressed patients.
Steve’s other interest is supervision and education and he leads the supervision of trainees at the Alfred. He has completed further training in advanced healthcare simulation, public health and echocardiography.
He is fortunate to have an incredible wife and three amazing children and a kombi van called Lightning.
The ABC of ICU – The A is for antibiotics.
We debate perpetually how best to resuscitate patients - ABC! For the critically ill, septic patient the only therapy that really works is antibiotics! How and why must we get antibiotics right?
Sepsis is incredibly dangerous for our patients and very topical in ICU and Emergency. In intensive care and emergency medicine we rightly dissect and discuss extensively how best to resuscitate patients, Airway, Breathing, Circulation – the ABC! Our training focuses on the urgency and adequacy of resuscitation and the provision of excellent supportive care. However, for the critically ill, especially in sepsis, we have very few therapies available that actually change the natural history of illness and can cure our patients. Surely that is what being a doctor is all about – helping people and changing the course of their illness – giving the patient a chance to survive!
Over 75% of patients in ICU will receive antibiotics and the choice, timing and dose will directly influence your patients chance of surviving. Antibiotics are one of the few truly disease modifying therapies we have available and by far the one we utilize the most.
In addition, no other therapy is important to not only get right for the patient you are treating but, in the case of antibiotics, the therapy for one patient may influence other patients. Attention to correct antibiotic use might save the patient in front of you. However thoughtless antibiotic use might make it harder to save the next patient by increasing antibiotic resistance in your unit.
How and why must we get antibiotics right?