Microbiological specimens
Where source of septicaemia is known, please refer to guidance under relevant body systems. |
Infection: Presence of microorganisms in a normally sterile site.
Bacteraemia: Cultivable bacteria in the bloodstream.
Systemic Inflammatory Response Syndrome (SIRS):
SIRS is the systemic response to a wide range of stresses and is defined in adult patients as Two or more of:
Sepsis: Sepsis is defined as SIRS associated with proven or clinically suspected infection; Sepsis Pathway.
Severe sepsis: Sepsis associated with organ dysfunction (distant from infection site), hypoperfusion or hypotension (systolic BP <90mmHg, MAP <70mmHg or reduction of 40mmHg from baseline).
Septic shock: Sepsis with hypotension requiring pressor therapy despite adequate fluid resuscitation. In addition there are perfusion abnormalities that may include lactic acidosis, oliguria, altered mental status and acute lung injury.
Septicaemia: Sepsis associated with bacteraemia.
Diagnosed – organ dysfunction with ≥ 2 of the following:
WCC <4 or >12 x 109/L
Temp <36°C or >38°C
Heart rate >90bpm
Respiratory rate >20/min or PaCO2 <4.3kPa
Refer to Trust Guidelines and pathway on Surviving Sepsis.
Common Pathogen(s)
Multiple pathogens.
Antibiotic - 1st line Amoxicillin 2g q8h IV 5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min or MRSA/ MSSA colonised: Replace Amoxicillin with Flucloxacillin 2g q6h IV (MSSA) or Vancomycin IV (dosed as per trust vancomycin guideline) (MRSA). |
2nd Line Non-serious penicillin allergy (e.g rash) or patients with liver cirrhosis at risk of hepatorenal syndrome: 5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min or If history of anaphylaxis to penicillin – 5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min or |
Comment
Gentamicin*: 5mg/ kg but for elderly patients or with moderate/severe renal impairment(CrCl <30ml/min), may require 3mg/ kg or shorter duration treatment.
All hospital admissions MUST receive a screen for MSSA/ MRSA as per local policy.
All patients with MSSA or MRSA bacteraemia must receive an echocardiogram and at least 14 days of IV treatment with clearance blood culture after 48h.
Duration of therapy – as per clinical response
Common pathogen(s)
Gram positive, gram negative organisms and anaerobes
Pregnant: 5mg/kg IV q24h for 24-48hours only (max 500mg): if <70 years and CrCl≥30mL/min or Use booking in weight or if patient is obese ie. 20% over ideal body weight - use adjusted body weight Consider Listeriosis – consider specific treatment with microbiologist Post Partum (Not Breast Feeding): 5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min or CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation. If patient is obese ie. 20% over ideal body weight - use adjusted body weight Post Partum (Breast Feeding): 5mg/kg IV one stat dose (max 500mg): if <70 years and CrCl≥30mL/min or
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Comment
Gentamicin - Due to the limited data and the theoretical risk of ototoxicity and nephrotoxicity, the use of parenteral gentamicin in pregnancy is reserved except for the treatment of serious or life-threatening conditions unresponsive to standard antibiotic therapy. If parenteral gentamicin is required in pregnancy, close monitoring of maternal serum concentrations is advised, with the dose being adjusted as necessary.
References
Microbiological specimens
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Duration of therapy 2 weeks
Common Pathogen(s)
Staphylococcus aureus;
Hickman/ long lines may have Enterobacteriaceae.
Antibiotic - 1st line Vancomycin IV (dosed as per trust vancomycin guideline) 5mg/kg IV one stat dose (max 500mg): if <70 years and CrCl≥30mL/min or
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Comment
Remove line. Switch to Flucloxacillin if isolate proves to be MSSA.
Gentamicin*: 5mg/ kg but for elderly patients or with moderate/severe renal impairment (CrCl<30ml/min), may require 3mg/ kg or shorter duration treatment.
Discuss all suspected cases of neutropenic sepsis with Haematologists/acute oncology team and Microbiologists
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Fever of 38.3°C or more on one occasion, or 38.0°C or more sustained for 1 hour in a patient at risk of neutropenia e.g.post chemotherapy.
Never wait for results before starting IV antibiotics.
Refer to Trust Policy for Management of Infection in Neutropenic Patients.
Common Pathogen(s)
Gram positive pathogens; Gram negative pathogens which can lead to shock, multiorgan failure and death
Antibiotic - 1st line Piperacillin-tazobactam 4.5g q8h IV 5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min or In renal impairment, use one single dose of Gentamicin only. |
2nd Line/penicillin allergy of all severity as per Christie policy-link Monitor closely if previous penicillin anaphylaxis. |
Comment
Discuss all suspected cases of neutropenic sepsis with Haematologists and Microbiologists
Identify source of infection.
Patients with pelvic/rectal/tooth symptoms NOT receiving Piperacillin-tazobactam, should have Metronidazole 400mg PO 8 hourly (500mg IV 8 hourly) added to cover anaerobic organisms
Do NOT use Vancomycin and Gentamicin together without Microbiology/
Haematology advice.