Systemic sepsis after organ transplantation
- Severe sepsis/ Septic shock are medical emergencies and require prompt treatment with effective antimicrobials
- Cases should be discussed with ICU (intensive care unit)
- Consult Micro/ID
- Treat according to sensitivity test results
- See also Sepsis Identification and Management
- Review empirical treatment within 48-72 hours
Preferred
piperacillin-tazobactam 4.5g iv stat (first dose) should be given as soon as possible (ideally within 60 mins) THEN one of the following regimens should be used, choose from:
piperacillin-tazobactam 4.5g iv qds (six hours after the initial stat dose)
OR
Extended infusion piperacillin-tazobactam 4.5g iv tds infuse each dose over 3-4 hours (six hours after the initial stat dose)
OR
Elastomeric pump piperacillin-tazobactam 13.5g over 24 hours (elastomeric device should be attached straight after the initial stat dose)
For MRSA positive patients: ADD vancomycin iv
Alternative
For penicillin allergy (non-severe)
ceftazidime 1g iv tds
For penicillin allergy (severe)
ciprofloxacin* 500mg po bd (400mg bd iv if unable to swallow)
For patients where abdominal focus of infection is suspected: add metronidazole 400mg tds po (500mg tds iv if unable to swallow)
For MRSA positive patients: add vancomycin iv
For patients with sepsis AND severe lobar pneumonia consider risk of Legionnaires: see Legionnaires disease
*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet.
Fluoroquinolones, including ciprofloxacin are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.