Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Gram-negative BSI

Note

Identification of primary source of infection is essential

Optimal management of BSI includes appropriate antimicrobial therapy as well as adequate source control (relief of urinary or biliary obstruction, removal of infected central venous catheters, drainage of intra-abdominal, pelvic, or deep tissue abscesses, etc.)

Empiric Antimicrobial Therapy

Community-Acquired (Non-Critically Ill)

Community-Acquired (Critically Ill)

May include:

  • Intensive care unit admission

  • High acute severity of illness score (Pitt bacteremia score ≥4)

  • Relatively high predicted mortality (BSI risk score ≥5)

Hospital-Acquired

Occurring ≥48 hours after hospital admission

Health Care-Associated

  • Prior hospitalization for ≥2 days in the past 90 days

  • Residence in nursing home or extended care facility

  • Home infusion therapy (chemotherapy, intravenous antibiotics, etc.)

  • Chronic dialysis

  • Home wound care within 30 days

Treatment Duration Guidelines

More Information

Gram-negative BSI References

Nimmich E, et al. Hosp Pharm 2017

BSI Duration Guidelines References
  1. Yahav D, et al. Seven versus fourteen days of antibiotic therapy for uncomplicated gram-negative bacteremia: A non-inferiority randomized controlled trial. Clin Infect Dis 2018. doi: 10.1093/cid/ciy1054. [Epub ahead of print]
  2. Nelson AN, et al. Optimal duration of antimicrobial therapy for uncomplicated gram-negative bloodstream infections. Infection 2017; 45: 613-20.
  3. Al-Hasan MN, et al. Reply to comments: Duration of antimicrobial therapy for gram-negative bacteremia secondary to urinary source of infection. Infection 2018; 46: 283-4.
  4. Rac H, et al. Evaluation of early clinical failure criteria for gram-negative bloodstream infections. Open Forum Infect Dis 2018; 5 (Suppl 1): S311-2.