Blood infections

Question 1

Community acquired septicaemia

Answer 1

A broad-spectrum antipseudomonal penicillin (e.g. piperacillin with tazobactam, ticarcillin with clavulanic acid) or a broad-spectrum cephalosporin (e.g. cefuroxime)
If meticillin-resistant Staphylococcus aureus suspected, add vancomycin (or teicoplanin).
If anaerobic infection suspected, add metronidazole to broad-spectrum cephalosporin.
If other resistant micro-organisms suspected, use a more broad-spectrum beta-lactam antibacterial (e.g. meropenem).

Question 2

Hospital acquired septicaemia

Answer 2

A broad-spectrum antipseudomonal beta-lactam antibacterial (e.g. piperacillin with tazobactam, ticarcillin with clavulanic acid, ceftazidime, imipenem with cilastatin, or meropenem)
If meticillin-resistant Staphylococcus aureus suspected, add vancomycin (or teicoplanin).
If anaerobic infection suspected, add metronidazole to broad-spectrum cephalosporin.

Question 3

Septicaemia related to vascular catheter

Answer 3

Vancomycin (or teicoplanin)
If Gram-negative sepsis suspected, especially in the immunocompromised, add a broad-spectrum antipseudomonal beta-lactam.
Consider removing vascular catheter, particularly if infection caused by Staphylococcus aureus, pseudomonas, or Candida species