Bacteremia

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