Positive blood cultures: actions to take
- Think Sepsis - prompt treatment could save this patient's life: Sepsis Identification and Management
- Check observations, renal function, drug chart, allergies
- Ensure handover to next team
- Consider discussion with on-call Micro SpR (and ITU) if clinical situation not straightforward
- If patient not reviewed in person, please ensure a clinical note is written in EPR
All patients will be automatically flagged to Micro/ID team via lab for next day urgent review
Review empirical treatment within 48-72 hours
Blood culture result is "presumptive Staphylococcus aureus"
- Ensure blood cultures are repeated within 72 hours since last positive blood culture
Preferred: flucloxacillin 2g iv qds
For penicillin allergy (non-severe): cefazolin* 2g iv tds
*Caution: Prothrombin time, INR and APTT may increase on cefazolin treatment courses, please monitor. For more information see Cefazolin associated coagulation disorders
For penicillin allergy (severe) or MRSA positive: teicoplanin iv (see teicoplanin monograph for dose banding, dose frequency and monitoring)
Blood culture result is "Gram-negative rods seen"
- If on amoxicillin or co-amoxiclav and observations stable, no action required
- If observations unstable and already on antibiotics, discuss with on-call Micro SpR
If NOT on antibiotics:
Preferred: amoxicillin 1g iv tds AND gentamicin 5mg/kg iv.
Gentamicin is for maximum of 3 days. Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.
For penicillin allergy (non-severe and severe):
co-trimoxazole 960mg po bd (or iv if NBM)
OR
gentamicin 5mg/kg iv. Gentamicin is for maximum of 3 days. Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.