From the FDA Drug Label
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From the Research
The appropriate management for a discharged patient with a positive blood culture result requires prompt evaluation and targeted antimicrobial therapy, with the patient being contacted immediately and either brought back to the hospital or seen urgently in an outpatient setting, depending on their clinical status and the identified pathogen. The patient's clinical status and the identified pathogen should guide the decision on whether to bring them back to the hospital or see them urgently in an outpatient setting. Initial empiric antibiotic therapy should be started based on the organism identified, with common choices including ceftriaxone 1-2g IV daily for gram-negative bacteria, vancomycin 15-20mg/kg IV every 12 hours for gram-positive cocci (especially if MRSA is suspected), or fluconazole 800mg loading dose followed by 400mg daily for candidemia, as suggested by 1.
This approach is supported by the study published in 2017, which highlights the importance of appropriate empirical antibiotic treatment for healthcare-associated infections, including bloodstream infections 1. The study found that the most common germs causing bloodstream infections were Escherichia coli, Klebsiella oxytoca, and methicillin-resistant Staphylococcus aureus, and proposed empiric antibiotic treatment regimens for these infections.
The duration of treatment typically ranges from 7-14 days for uncomplicated bacteremia, but may extend to 4-6 weeks for endocarditis or other complicated infections. Blood cultures should be repeated to document clearance of bacteremia, and a thorough evaluation for the source of infection should be conducted, including appropriate imaging studies or removal of infected devices if present. This aggressive approach is necessary because bacteremia represents a serious systemic infection that can lead to sepsis, endocarditis, metastatic infections, or death if inadequately treated, even in patients who initially appear well enough for discharge.
It is also important to note that patients discharged from the emergency department may not always be well-informed about their diagnosis, treatment, and follow-up care, as highlighted by the study published in 2013 2. Therefore, it is crucial to ensure that patients are provided with clear and comprehensive discharge instructions, and that they understand the importance of adhering to their treatment plan and follow-up appointments.
In terms of specific antibiotic regimens, the study published in 2006 found that cefepime, piperacillin-tazobactam, and meropenem are among the broadest-spectrum and most expensive antimicrobials, and that their use should be guided by established guidelines and protocols 3. The most recent study published in 2021 highlights the importance of investigating the characteristics and outcomes of patients who are discharged against medical advice, and utilizing this knowledge to improve the healthcare process 4.
Key considerations in the management of a discharged patient with a positive blood culture result include:
- Prompt evaluation and targeted antimicrobial therapy
- Clear and comprehensive discharge instructions
- Adherence to treatment plan and follow-up appointments
- Repeat blood cultures to document clearance of bacteremia
- Thorough evaluation for the source of infection, including imaging studies or removal of infected devices if present.
Overall, the management of a discharged patient with a positive blood culture result requires a comprehensive and aggressive approach, with a focus on prompt evaluation, targeted antimicrobial therapy, and clear communication with the patient.