How does the site of bacterial sepsis affect the selection of empiric antimicrobial therapy?

Updated: Feb 05, 2019
  • Author: Amber Mahmood Bokhari, MBBS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Appropriate empiric antimicrobial therapy depends on adequate coverage of the presumed pathogen(s) responsible for the septic process, potential antimicrobial resistance patterns, and patient-specific issues such as drug allergies or chronic medical conditions. Tying sites of infection to specific pathogens should occur, as follows:

  • Intravenous line infections: Consider broad-spectrum coverage for gram-positive organisms, especially methicillin-resistant Staphylococcus aureus (MRSA) (linezolid, vancomycin, or daptomycin) and gram-negative nosocomial pathogens (especially Pseudomonas species and other Enterobacteriaceae [piperacillin-tazobactam, carbapenems, or cefepime]), and line removal. Some of these may be Candida infections.
  • Biliary tract infections: Typical bacterial agents include Enterobacteriaceae, gut-associated anaerobes, and Enterococcus. Consider carbapenems, piperacillin-tazobactam, cephalosporins, or quinolones in combination with an anaerobic agent such as metronidazole.
  • Intra-abdominal and pelvic infections: Typically Enterobacteriaceae, gut-associated anaerobes, or Enterococcus (carbapenems, piperacillin-tazobactam, or cephalosporins or quinolones in combination with an anaerobic agent such as metronidazole)
  • Urosepsis: Typically Enterobacteriaceae or Enterococcus (carbapenems, piperacillin-tazobactam, cephalosporins, quinolones, or aminoglycosides)
  • Pneumococcal sepsis: Third-generation cephalosporins, respiratory quinolone (levofloxacin or moxifloxacin), carbapenem, or vancomycin if resistance is suspected
  • Sepsis of unknown origin: Meropenem, imipenem, piperacillin-tazobactam, or tigecycline; metronidazole plus levofloxacin, cefepime, or ceftriaxone may be alternatives

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