Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

Critically Ill with Risk Factors

Risk Factors

  • Prolonged use of broad-spectrum antibiotics

  • Immunocompromised

  • Hematologic malignancy

  • Receipt of bone marrow or solid-organ transplant

Coverage

Gram Positive

  • Staphylococcus

  • Streptococcus

  • Enterococcus

Gram Negative

  • Pseudomonas

  • Enteric organisms

Empiric Regimen

Vancomycin 15-20mg/kg IV Q12H

Dose to a target trough level of 15-20 mg/L

PLUS

Piperacillin-tazobactam 4.5g IV Q6H