LIVERPOOL CLINICAL LABORATORIES Empirical Management of Infection on Critical Care Units at AUH and RLUH Patricia Crossey (Critical Care Pharmacist, RLUH), Alison Hall (ITU Consultant, RLUH), Jenifer Mason (Microbiology Consultant LCL), Robert Parker (ITU Consultant, AUH) and Clare Sales (Critical Care Pharmacist, AUH) 2017 These Guidelines refer to common ITU presentations and relate to empirical management only. For indications not covered refer to the Trust Antibiotic Formulary (Royal and Aintree). Enquiries to: [email protected] or [email protected] Contents General Principles ............................................................................................................................................................................................. 2 Abdominal Infection .......................................................................................................................................................................................... 3 Non Healthcare associated Intra-abdominal Infection................................................................................................................................. 3 Healthcare associated intra-abdominal infection ........................................................................................................................................ 4 Variceal bleeds and acute liver failure ......................................................................................................................................................... 4 Central Nervous System .................................................................................................................................................................................... 5 Meningitis/Encephalitis ............................................................................................................................................................................... 5 ENT or Dental Infection ..................................................................................................................................................................................... 6 Epiglottitis .................................................................................................................................................................................................... 6 Dental Abscess or other oral infection ......................................................................................................................................................... 6 Respiratory Tract Infection ................................................................................................................................................................................ 7 Community acquired pneumonia ................................................................................................................................................................ 7 Hospital Acquired Pneumonia or Ventilator Associated Pneumonia ........................................................................................................... 7 Aspiration Pneumonia ................................................................................................................................................................................. 8 Infective Exacerbation of Chronic Lung Disease (COPD, bronchiectasis) ..................................................................................................... 8 Suspected influenza with concurrent pneumonia........................................................................................................................................ 8 Sepsis of Unknown Origin.................................................................................................................................................................................. 9 Sepsis of Unknown Origin – Non Neutropenic ............................................................................................................................................. 9 Neutropenic Sepsis ...................................................................................................................................................................................... 9 Skin and Soft Tissue Infection .......................................................................................................................................................................... 10 Necrotising soft tissue infection of any anatomical site ............................................................................................................................. 10 Cellulitis ..................................................................................................................................................................................................... 10 Trauma Prophylaxis ......................................................................................................................................................................................... 11 Prophylaxis in head and neck trauma ........................................................................................................................................................ 11 Prophylaxis for Compound Fractures ......................................................................................................................................................... 11 Selective Decontamination of the Digestive Tract ......................................................................................... 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Urosepsis ......................................................................................................................................................................................................... 13 Urosepsis/pyelonephritis ........................................................................................................................................................................... 13 Appendix ......................................................................................................................................................................................................... 14 Infection Control Precautions .................................................................................................................................................................... 14 Weekly Screening ...................................................................................................................................................................................... 15 Notifiable Diseases..................................................................................................................................................................................... 17 Tetanus Prone Wounds .............................................................................................................................................................................. 18 Processing Urgent Specimens Out of Hours (Mon-Fri 1630-0900 and Sat-Sun) ......................................................................................... 19 Gentamicin and Teicoplanin Dosing ........................................................................................................................................................... 21 Gentamicin ........................................................................................................................................................................................... 21 Teicoplanin ........................................................................................................................................................................................... 21 Contact Details ........................................................................................................................................................................................... 21 1 For Teicoplanin and Gentamicin Dosing refer to Appendix. Maximum dose of Gentamicin is 450mg/24 hours. Page 1 General Principles 1. Antibiotic treatment should NEVER be delayed in an emergency. However, wherever possible, microbiological specimens should always be obtained before antibiotic therapy is commenced 2. Prior to antibiotic therapy patients should ALWAYS have TWO sets of blood cultures taken i.e. x2 aerobic and x2 anaerobic bottles. If there are lines present culture from the line AND a peripheral site. Send other specimens as appropriate (respiratory, drain fluid, wound swabs etc.) 3. Always check previous Microbiology results, with particular attention to resistant organisms (see below for common resistance patterns). Note the empirical antibiotic choice may not cover resistant organisms – please discuss with Microbiology if unsure 4. Antibiotics are not a substitute for source control (i.e. surgical drainage of an abscess) 5. Antibiotics should be administered within 1 hour in patients with signs of severe sepsis or septic shock 6. Allergy status must be checked BEFORE prescribing and administering any antibiotic and documented on the patient’s drug chart, including where possible the nature of the allergy 7. An antibiotic history should be taken and recorded in the critical care notes 8. All antibiotic prescriptions should have an indication, start date and review or stop date. 9. These guidelines are for empirical management only. Antibiotics should be focussed at the