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Table 2 Suggested empirical antimicrobial treatment of bloodstream infections according to source of infection and place of acquisition (adapted from international guidelines and local pratice)[49–55]

From: Treatment of bloodstream infections in ICUs

Site

Pathogens

Suggested empirical antibiotic

Urinary tract infection

Enterobacteriacae including

- Ceftriaxone for CAB or ceftazidime for HAB or ICU AB (if suspicion of P. aeruginosa)

- Escherichia coli

± aminoglycosides

Other enterobacteiraceae

NB: Consider the risk of ESBL and administer a penem in case of hish risk (CA and recent travel to high risk countries, other situations in case of previous colonization, invasive procedure use, previous antibiotic therapy especially in case of septic shock)

Pseudomonas aeruginosa

Enterococcus sp.

Staphylococcus sp.

Intra-abdominal sepsis

Gram negative bacilli including

- Piperacillin-tazobactam

- Escherichia coli (all BSIs)

- Cephalosporin active against P. aeruginosa + metronidazole

- other enterobacteriaceae (all BSIs)

- Carbapenem (high-risk patients)

- Pseudomonas aeruginosa (HA and

± fluconazole

ICU BSI)

± aminoglycoside

Gram positive Cocci including

- Enterococcus sp.

Anaerobes including Bacteroides

Candida

CA and HCA pneumonia

S pneumoniae (CA BSI)

- Third generation cephalosporin (macrolides in case of suspicion of intracellular bacteria will be added initially).

S aureus (HCA BSI)

E coli (HCA BSI)

- NB: In case of HCA, consider the risk of MRSA or ESBL E coli.

Hospital acquired pneumonia

Enterobacteriacae

- Beta-lactam active against P. aeruginosa ± aminoglycoside ± glycopeptide or linezolid if suspicion of methicillin-resistant Staphylococcus aureus

Pseudomonas aeruginosa

Staphylococcus aureus

Streptococcus pneumoniae

Haemophilus influenzae

Ventilator-associated pneumonia (no risk factor for multi-drug resistant pathogen)

Staphylococcus aureus

- Third generation cephalosporins

Streptococcus pneumoniae

± aminoglycosides or fluoroquinolones

Haemophilus influenzae

Anaerobes

Catheter-related infection

Staphylococcus sp.

- Glycopeptide or linezolid + beta-lactam active against Pseudomonas aeruginosa

Enterobacteriacae

NB: Consider the risk of candidaemia in case of previous Candida colonization,

Pseudomonas aeruginosa

 
 

Candida sp.

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