Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Bloodstream Infection De-escalation Guide

De-escalation Steps
  1. Blood Cx drawn
  2. Gram stain
  3. Film Array BCID
  4. MALDI-TOF Microscan
  5. In Vitro Susceptibility Testing

Gram-Negative Bacteria

Enterobacteriaceae
(No chromosomal AmpC production)

  • Escherichia coli

  • Klebsiella pneumoniae

  • Klebsiella oxytoca

  • Proteus mirabilis

Enterobacteriaceae
(Chromosomal AmpC production)

  • Enterobacter cloacae

  • Serratia marcescens

Non-Enterobacteriaceae
(Non-fermenters)

  • Pseudomonas aeruginosa

  • Acinetobacter baumannii

Miscellaneous

  • Haemophilus influenzae

  • Neisseria meningitidis

Gram-Positive Bacteria

Staphylococcus aureus (MSSA)
(MecA not detected)

Staphylococcus aureus (MRSA)
(MecA detected)

Staphylococcus species
(S. aureus not detected)

Coagulase negative staphylococci

Beta-hemolytic streptococci

  • Streptococcus pyogenes (group A)

  • Streptococcus agalactiae (group B)

Streptococcus pneumoniae

Enterococcus species
(Non-VRE (VanA/B not detected))

Enterococcus species
(VRE (VanA/B detected))

Other Treatment Notes

Oral antimicrobial options for gram-positive bloodstream infections (BSI)

Treatment duration of gram-positive BSI

More Information

References
  1. Augustine MR, Testerman TL, Justo JA, et al. Clinical risk score for prediction of extended-spectrum beta-lactamase producing Enterobacteriaceae in bloodstream isolates. Infect Control Hosp Epidemiol 2017; 38: 266-272.
  2. Bookstaver PB, Nimmich EB, Smith TJ 3rd, et al. Cumulative effect of an antimicrobial stewardship and rapid diagnostic testing bundle on early streamlining of antimicrobial therapy in gram-negative bloodstream infections. Antimicrob Agents Chemother 2017; 16: e00189-17.
  3. Derrick C, Justo JA, Lu ZK, et al. Evaluation of clinical outcomes in bloodstream infections secondary to chromosomally-mediated AmpC-producing Enterobacteriaceae. 55th ICAAC annual meeting, September 2015; San Diego, CA, USA.
  4. Troficanto C, Kohn J, Justo JA, et al. Utility of combination antimicrobial therapy for bloodstream infections due to Enterobacteriaceae and non-fermenting gram-negative bacilli. ASM Microbe, June 2016; Boston, MA, USA.
  5. Kutob LF, Justo JA, Bookstaver PB, et al. Effectiveness of oral antibiotics for definitive therapy of gram-negative bloodstream infections. Int J Antimicrob Agents 2016; 48: 498-503.
  6. Nelson AN, Justo JA, Bookstaver PB, et al. Optimal duration of antimicrobial therapy for uncomplicated gram-negative bloodstream infections. Infection 2017; 45: 613-20.
  7. Watson CM, Al-Hasan MN. Bloodstream infections and central line-associated bloodstream infections. Sur Clin N Am 2014; 94: 1233-1244