Do We Need to Follow International Guidelines for Empirical Antibiotics Selection in Critically Sick Children? A Case series

Abstract

Background: Sepsis is a leading cause of pediatric critical illness and mortality. Choosing empiric antibiotics based solely on international guidance may be inadequate where local resistance patterns differ. Methods (Case Series Description): We describe two infant cases with rapidly progressive septic shock, purpuric/necrotic skin lesions, and multi-organ failure. Results: Blood/CSF/lesion cultures in both cases grew Pseudomonas aeruginosa resistant to initial ceftriaxone+vancomycin; one isolate was imipenem-susceptible after escalation. Despite maximal organ support, both infants died. Conclusion: While international guidelines standardize care, empiric therapy in critically ill children should be tailored to local epidemiology and AMR surveillance, ensuring early coverage for Pseudomonas where prevalence warrants.