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Obtain history, perform a physical examination, and obtain appropriate laboratory studies
o
o
o
CMP, CBC
Blood Cultures (x 2 sets) prior to antimicrobial therapy
Culture and Gram stain (optional for low-risk patients) representative of source of infection (intraoperative or via drain). This is optional for uncomplicated, immunocompetent patients.
NOTE: Adequate source control is essential in treatment any infectious disease, however, certain instances will predict
clinical failure with source control measures. High risk patients are those with co-morbidities or risk factors that will
decrease the likelihood of treatment success and increase infection severity (example: anatomically unfavorable
infection or a health careassociated infection).
Low to Moderate
Risk/Severity
High Risk/Severity
(indluding
immunocompromised
patients)
Piperacillin/tazobactam
3.375gm IV every 6 hours
* Vancomycin MUST be added to Aztreonam therapy as this agent only provides coverage for gram-negative aerobic bacteria. Contact
pharmacist for dosing recommendations.
Emphasis should be placed on the timeliness of antimicrobial therapy. Please administer first doses STAT.
Table 2: Healthcare Associated Intra-abdominal Infection (either nosocomial onset or community onset in a patient
with presence of an invasive device, history of MRSA colonization, or recent hospitalization or surgery).
Recommended
Alternative
Penicillin Allergy (Anaphylaxis)
Nosocomial Infection
Piperacillin/tazobactam
4.5gm IV every 6 hours
Coverage of
enterococci
Patients known to be colonized with multidrug-resistant gram-negative organisms should receive therapy which
includes coverage of the colonizing organism(s). In these cases, agents other than those listed above may be
necessary (i.e. doripenem, etc.). In penicillin-allergic patients, tigecycline has been shown to be a reasonable
alternative, but provides NO anti-pseudomonal activity. Infectious Diseases consultation is recommended.
Antifungal Therapy
Antifungal therapy with micafungin may be considered in critically ill patients. Antifungal therapy should be used
in patients where fungi are isolated in culture.
* Vancomycin MUST be added to Aztreonam therapy as this agent only provides coverage for gram-negative aerobic bacteria. Contact
pharmacist for dosing recommendations.
-Emphasis should be placed on the timeliness of antimicrobial therapy. Please administer first doses STAT.
-Major Reference (SIS/IDSA Guidelines): Solomkin, et al. Clinical Infectious Diseases 2010; 50:133-64.