Gram-negative bacteremia
From IDWiki
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 (ceftriaxone susceptibility is fairly good for predicting cefixime susceptibility1)
References
- ^ Kimberly C. Claeys, Patricia J. Simner, Tsigereda Tekle, Anthony D. Harris, Emily Jacobs, Sara E. Cosgrove, Pranita D. Tamma. Ryan K. Shields. How accurate is ceftriaxone at predicting susceptibility of enterobacterales isolates to oral higher-generation cephalosporins?. Antimicrobial Agents and Chemotherapy. 2025;69(2). doi:10.1128/aac.01387-24.
