LAB WORK
  • Gram (-) rod, non-lactose fermenter, most are oxidase (+)

TREATMENT OPTIONS
  • ​Antipseudomonal penicillins (extended infusions preferred)
    • ​Piperacillin
    • Piperacillin/tazobactam (Zosyn)
    • Ticarcillin/clavulanate (Timentin)
  • ​Cephalosporins
    • ​Cefepime (4th gen)
    • Ceftazidime (3rd gen)
  • ​Monobactams
    • ​Aztreonam
  • ​​​Carbapenems
    • ​Imipenem
    • Meropenem
    • Doripenem
    • DO NOT USE ERTAPENEM
  • ​Aminoglycosides
    • ​Typically, gentamicin < tobramycin < amikacin as far as activity
    • Once daily dosing preferred
  • ​Fluoroquinolones
    • Cipro and Levaquin only
  • ​Polymyxins (colistin and Polymyxin B)
    • ​For MDR strains

​CLINICAL NOTES
  • ​Double Coverage
    • ​Used empirically to ensure activity before culture results available in critical illness or patients with MDR strain risk
    • Use agents from different classes (e.g., Antipseudomonal beta-lactam + aminoglycoside)
    • ​De-escalation recommended after culture results available
  • Risk Factors: mechanical ventilation, significant burns, surgery, indwellig catheters, IV drug abuse, recent antibiotic treatment, prolonged hospitalization, extended care facility residents, immunosuppression (steroids, neutropenia), cystic fibrosis