Enterobacteriaceae

Organisms

Escherichia coli

Klebsiella pneumoniae

Klebsiella oxytoca

Proteus mirabilis

BCID-Based De-Escalation Options

Ceftriaxone

Susceptibility-Based De-Escalation Options IV (Narrowest-Spectrum Susceptible Agent)

Ampicillin

Ampicillin/sulbactam

Cefazolin

Ceftriaxone

Susceptibility-Based De-Escalation Options PO (For Transitions Of Care)

Levofloxacin

Ciprofloxacin

TMP/SMX

Primarily for urinary source

Notes

E. coli, Klebsiella spp. and P. mirabilis represent >75% of gram-negative bloodstream isolates

Patients with an ESBL Prediction Score <1 (no known colonization with ESBL-producing Enterobacteriaceae and no prior use of beta-lactams or fluoroquinolones within past 3 months) have a predicted probability of BSI due to ESBL-producing Enterobacteriaceae <1%.

De-escalation to ceftriaxone is recommended in these patients based on identification of bloodstream isolate as E. coli, Klebsiella spp. or P. mirabilis

Ertapenem is the preferred agent in patients with high suspicion (ESBL Prediction Score ≥3) or confirmed BSI due to ESBL-producing Enterobacteriaceae