Gram-negative bacteremia

Clinical Manifestations

• Source of bacteremia
  • Respiratory tract infection (especially critically ill patients)
  • Central line-associated bloodstream infection (especially critically ill patients)
  • Urinary tract infection (most common source in elderly patients)
  • Gastrointestinal or biliary tracts
  • Skin and soft tissue infection

Management

• Duration of 7 days of antibiotics is likely reasonable for most uncomplicated gram-negative bacteremias, regardless of source
• Can be narrowed based on antibiotic spectrum
• Can be switched or oral antibiotics once stable
  • Highly bioavailable non-beta-lactams: ciprofloxacin, levofloxacin, moxifloxacin (if not a urinary source), or co-trimoxazole
  • Beta-lactams: amoxicillin, amoxicillin-clavulanic acid, cephalexin, cefadroxil, cefixime; can consider the following higher doses
    • Amoxicillin 1 g p.o. three times daily
    • Amoxicillin-clavulanic acid 875 mg/125 mg p.o. three times daily
    • Cephalexin 1 g p.o. four times daily
    • Cefadroxil 1 g p.o. twice daily
    • Cefixime 400 mg p.o. twice daily (corresponds to usual dose)