Bacteremia: Interpreting Verigene® Results – VASP
Background
-
-
- When BCx turn positive, the lab reports Gm stain and Verigene® results to help guide empiric therapy, while awaiting further species identification and susceptibilities.
Management
- Start empiric antibiotic therapy (based on clinical picture and table below)
- Consider ordering repeat BCx x2 based on organism to document clearance
- Repeat for: Staph (MRSA or MSSA), Strep lugdunensis
- If source control & no endovascular infxn, no need to repeat (most other strep and GNR’s
- VUMC antibiograms can be used to reference typical resistance patterns and most common organisms in blood cultures.
- Consider clinical picture: Do you have a likely source of bacteremia? Do you need to consider/assess for additional sources of infection?
- Candida in a blood culture is NEVER considered a contaminant
- Do not hesitate to consult Infectious Diseases (or page 615-317-GERM) with questions
- Species identification and susceptibility is available in 2-3 days from positive culture
GRAM POSITIVE COCCI
|
Organism |
Resistance Marker |
Preliminary Recommendation |
|
Staphylococcus aureus or Staphylococcus lugdunensis |
mecA detected |
Start vancomycin IV |
|
No mecA detected |
Start nafcillin or cefazolin Stop empiric vancomycin IV |
|
|
Staphylococcus epidermidis - Often skin contaminant - Repeat cultures, start therapy if uncertain |
mecA detected |
Start vancomycin IV |
|
No mecA detected |
Start nafcillin or cefazolin Stop empiric vancomycin IV |
|
|
Other coagulase negative Staph Often skin contaminant Repeat cultures start abx if uncertain |
|
Start vancomycin IV |
|
Streptococcus: agalactiae, pyogenes, anginosus |
|
Start penicillin IV Stop empiric vancomycin |
|
Streptococcus pneumoniae |
|
Start ceftriaxone Stop empiric vancomycin Await PCN sensitivity data |
|
Other Streptococcus |
|
Continue empiric vancomycin, awaiting susceptibilities |
|
Enterococcus faecalis |
vanA or vanB detected |
Start daptomycin 8-10mg/kg/day IV Don’t treat w vancomycin IV Contact precautions |
|
No vanA or vanB |
Start ampicillin Stop empiric vancomycin IV |
|
|
Enterococcus faecium |
vanA or vanB detected |
Start daptomycin 8-10mg/kg/day IV Don’t treat w vancomycin IV Contact precautions |
|
No vanA or vanB |
Start vancomycin IV |
GRAM POSITIVE RODS
|
Organism |
Preliminary Recommendation |
|
Listeria monocytogenes |
Start ampicillin Stop empiric vancomycin IV |
|
Other Gram positive rod Often skin contaminant Repeat cultures, start therapy if uncertain |
Start vancomycin IV |
GRAM NEGATIVE RODS *Consult ID if carbapenem resistance detected*
|
Organism |
Resistance Marker |
Preliminary Recommendation |
|
Acinetobacter species |
None |
Start IV meropenem 1g q8h IV until sensitivities available |
|
ESBL (CTX-M) |
Start meropenem 1g q8h IV Consider ID consult Contact precautions |
|
|
carbapenem resistance |
Consult Infectious Diseases Contact precautions |
|
|
Citrobacter or Serratia species |
None |
Start cefepime 2g q8h IV |
|
ESBL (CTX-M) |
Start carbapenem therapy contact precautions |
|
|
carbapenem resistance |
Consult Infectious Diseases Contact precautions |
|
|
Enterobacter species |
None |
Start cefepime 2g q8h IV |
|
ESBL (CTX-M) |
Start carbapenem therapy contact precautions |
|
|
carbapenem resistance |
Consult Infectious Diseases Contact precautions |
|
|
Escherichia coli |
None |
Start IV ceftriaxone 2g q24h IV |
|
ESBL (CTX-M) |
Start carbapenem therapy Contact precautions |
|
|
carbapenem resistance |
Consult Infectious Diseases Contact precautions |
|
|
Klebsiella pneumoniae or oxytoca |
None |
Start ceftriaxone 2g q24h IV |
|
ESBL (CTX-M) |
Start carbapenem therapy Contact precautions |
|
|
carbapenem resistance |
Consult Infectious Diseases Contact precautions |
|
|
Proteus species |
None |
Start ceftriaxone 2g q24h IV |
|
ESBL (CTX-M) |
Start carbapenem therapy Contact precautions |
|
|
carbapenem resistance |
Consult Infectious Diseases Contact precautions |
|
|
Pseudomonas aeruginosa |
None |
Start IV cefepime 2g q8h IV |
|
ESBL (CTX-M) |
Start meropenem (do not start ertapenem) Contact precautions |
|
|
carbapenem resistance |
Consult Infectious Diseases Contact precautions |