2023. Development of Institution-Specific Sepsis Guidelines for Double Coverage of Gram-Negative Infections
Session: Poster Abstract Session: Antimicrobial Resistant Infections: Treatment
Saturday, October 29, 2016
Room: Poster Hall
  • Vaughan_IDWeek Poster 2016.pdf (507.3 kB)
  • Background:

    Empiric antibiotic coverage for gram-negative organisms (GNO) is often directed at Pseudomonas aeruginosa. At Virginia Commonwealth University Medical Center (VCU), levofloxacin is the most common agent added to provide double coverage. The gram-negative bacilli most commonly responsible for infections at VCU Health are Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa with reported levofloxacin susceptibility of 74%, 94%, and 75%, respectively.


    We performed a retrospective electronic health record review of adult patients admitted to VCU from 1/1/2014 to 12/31/2014. Patients admitted with a diagnosis of sepsis, severe sepsis, or septic shock and an infection documented by positive culture with a GNO were identified. The primary objective of this study was to determine the adequacy of various empiric antibiotic combinations for each positive culture.


    A total of 1,862 patients were identified. 54% (1,000) were randomly selected for review. A total of 219 patients met the inclusion criteria. 11% of patients did not receive antibiotics within 12 hours of cultures. For patients who received antibiotics targeting multi-drug resistant GNOs, 56% received a single agent; only 21% received 2 antibiotics. 84% of GNOs were susceptible to piperacillin-tazobactam. The addition of levofloxacin did not result in increased susceptibilities when used in combination with cefepime and meropenem, but did provide an approximately 8% increase in coverage when used in combination with piperacillin-tazobactam. The addition of gentamicin resulted in only about a 3% increase in coverage for cefepime and meropenem, but provided an additional 13% of coverage when used in combination with piperacillin-tazobactam.


    In this cohort of septic patients at VCU, gentamicin provided broader gram-negative coverage when compared to levofloxacin. Although susceptibility to piperacillin-tazobactam alone was relatively low, the combination of piperacillin-tazobactam and gentamicin provided nearly equivalent coverage to meropenem and gentamicin.


    Dalemarie Vaughan, PharmD, BCPS1, Amy Pakyz, PharmD, MS, PhD1, Michael Stevens, MD, MPH2 and Shaina Bernard, PharmD, BCPS3, (1)Virginia Commonwealth University, Richmond, VA, (2)Infectious Diseases, Virginia Commonwealth University, Richmond, VA, (3)Hospital of the University of Pennsylvania, Philadelphia, PA


    D. Vaughan, None

    A. Pakyz, None

    M. Stevens, None

    S. Bernard, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.