Healthcare-acquired sepsis and/or previous antibiotic therapy

Diagnosis Common Pathogens Drug(s) of First Choice Alternative Drug(s) Comments Expected Duration

Healthcare-acquired sepsis and/or previous antibiotic therapy

Enterobacteriaceae

S. aureus

Streptococci spp.

P. aeruginosa

Vancomycin

PLUS one OF:

Piperacillin/

tazobactam

OR

Cefepime

OR

Meropenem*

ALL WITH OR WITHOUT

Tobramycin

For severe beta-lactam allergy:

Vancomycin

PLUS

Metronidazole

PLUS

Aztreonam

WITH OR WITHOUT

Tobramycin

Weigh risks and benefits of adding aminoglycoside for critical illness, immunocompromise, or history of infection or colonization with drug-resistant Gram-negative rods

Refer to the UCSF Code Sepsis Guidelines

*For patients with neutropenia, organ transplant, severe hepatic failure, or current/recent (<7 days) piperacillin/tazobactam or cefepime

Stop antibiotics at 48 hours if work-up does not reveal a source of infection

Duration should otherwise be tailored to clinical or microbiological source

Link here to FN and LTU guidelines