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Table 2 Suggested empirical antimicrobial treatment of bloodstream infections according to source of infection and place of acquisition (adapted from international guidelines and local pratice)[4955]

From: Treatment of bloodstream infections in ICUs

Site Pathogens Suggested empirical antibiotic
Urinary tract infection Enterobacteriacae including - Ceftriaxone for CAB or ceftazidime for HAB or ICU AB (if suspicion of P. aeruginosa)
- Escherichia coli ± aminoglycosides
Other enterobacteiraceae NB: Consider the risk of ESBL and administer a penem in case of hish risk (CA and recent travel to high risk countries, other situations in case of previous colonization, invasive procedure use, previous antibiotic therapy especially in case of septic shock)
Pseudomonas aeruginosa
Enterococcus sp.
Staphylococcus sp.
Intra-abdominal sepsis Gram negative bacilli including - Piperacillin-tazobactam
- Escherichia coli (all BSIs) - Cephalosporin active against P. aeruginosa + metronidazole
- other enterobacteriaceae (all BSIs) - Carbapenem (high-risk patients)
- Pseudomonas aeruginosa (HA and ± fluconazole
ICU BSI) ± aminoglycoside
Gram positive Cocci including
- Enterococcus sp.
Anaerobes including Bacteroides
Candida
CA and HCA pneumonia S pneumoniae (CA BSI) - Third generation cephalosporin (macrolides in case of suspicion of intracellular bacteria will be added initially).
S aureus (HCA BSI)
E coli (HCA BSI) - NB: In case of HCA, consider the risk of MRSA or ESBL E coli.
Hospital acquired pneumonia Enterobacteriacae - Beta-lactam active against P. aeruginosa ± aminoglycoside ± glycopeptide or linezolid if suspicion of methicillin-resistant Staphylococcus aureus
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus pneumoniae
Haemophilus influenzae
Ventilator-associated pneumonia (no risk factor for multi-drug resistant pathogen) Staphylococcus aureus - Third generation cephalosporins
Streptococcus pneumoniae ± aminoglycosides or fluoroquinolones
Haemophilus influenzae
Anaerobes
Catheter-related infection Staphylococcus sp. - Glycopeptide or linezolid + beta-lactam active against Pseudomonas aeruginosa
Enterobacteriacae NB: Consider the risk of candidaemia in case of previous Candida colonization,
Pseudomonas aeruginosa  
  Candida sp.