Bacteremia
VBMC TRAUMA CARE SERVICES GUIDELINE
Bacteremia (Antimicrobial Duration and Follow-Up Cultures)
Vascular catheters cause most bacteremia in hospitalized patients. Patients with and without vascular catheters may also develop bacteremia from remote infections-pneumonia, UTI, intra-abdominal infection, necrotizing soft tissue infection, burn wound infection, etc. Blood cultures should be obtained selectively in patients who exhibit signs and symptoms of severe infection.
Positive blood cultures may represent contamination during collection or processing. Cultures that become ‘positive’ quickly (12-24 hours) or that are positive in multiple bottles are likely to be true positives. Procalcitonin can also be used to adjudicate a contaminant versus a true positive. Listed below is a guideline for duration of antimicrobial therapy and interval of follow-up cultures.
Guideline for management of the most common type of bacteremia—that caused by Staphylococcus aureus.
Antimicrobial Duration
Guidelines for the Treatment of Adults with Bacteremia
Guidelines for the Treatment of Adults
with Bacteremia due to Staphylococcus aureus
I. Source
control
a. Remove
infected catheters and drain infected abscesses as soon as patient is
clinically stable
i. Patients
with CVCs as the source of infection are more likely to have persistent
bacteremia
ii. Foci
of infection that are not eradicated are associated with higher rates of
mortality & relapse
b. Evaluate
for metastatic disease (e.g., endocarditis, osteomyelitis)
i. Determine
risk for IE based on Duke’s criteria
ii. Obtain
echocardiography to evaluate to IE if suspected
1. TTE is
highly sensitive and should be obtained within 12 hours of initial evaluation
2. If TTE
negative but high suspicion of IE (e.g., persistent bacteremia, prosthetic
heart valve, pacemaker), TEE should be obtained.
iii. Consult
cardiology
1. IE
with prosthetic valve
2. TTE
positive
iv. ID
should be consulted for endocarditis
II. Document
clearance – repeat blood cultures every 48 hours until bacteremia cleared
III. Targeted
antimicrobial therapy
a. MSSA
i. Cefazolin
2g q8h or nafcillin 12g q24h (cont. infusion)
ii. If
considering using other beta-lactam antibiotics, consider ID consult
b. MRSA
i. Vancomycin
dosed to obtain trough level 15-20mcg/mL (may consider 10-15mcg/mL based on
source and response)
ii. For
persistent bacteremia or lack of clinical improvement
1. Ensure
adequate source control
2. Consider
ID consult
3. Daptomycin
6-10mg/kg q24h (ABW if BMI < 30, DBW if BMI ≥ 30)
4. Ceftaroline
600mg q8-12h
IV. Duration
of therapy
a. Uncomplicated
bacteremia can be treated for 2 weeks from negative culture
i. No
IE or osteomyelitis
ii. No
implanted prostheses
iii. Documented
clearance of bacteremia within 96 hours of first culture
iv. Defervescence
within 72 hours of appropriate therapy
b. Longer
duration of treatment
i. Osteomyelitis
(inc. prosthetic joint infections) or IE – 6-8 weeks
ii. Persistent
bacteremia/fever – 4 weeks
References
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1997; 30: 1072-8.
Hawkins C, et al. Arch Intern Med
2007; 167; 1861-7.
Joseph JP, et al. J Antimocrob
Chemother 2013; 68: 444-9.
Kaasch AJ, et al. Clin Infect Dis
2011; 51: 1-9.
Kullar R, et al. Clin Infect Dis 2011;
52: 975-81.
Liu C, et al. Clin Infect Dis 2011;
52: 1-38.
Lopez-Cortes LE, et al. Clin Infect
Dis 2013; 57: 1225-33.
Murray KP, et al. Clin Infect Dis
2013; 56: 1562-9.
Sakoulas G, et al. Clin Ther 2014; 36:
1317-33.
Schweizer ML, et al. BMC Infect Dis
2011; 11: 279.
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2011; 49: 3669-72.