bacteremia

[obiwan]

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i've noticed some variability in how these types of patients are managed at my hospital from various hospitalists in our group and never really realized that there would such differences

patient comes in with + blood and urine culture for instance enterococcus. repeat blood culture negative and no complications with patient. do you 1) send them out with IV abx and PICC line and 2) do they need an echo

for me, its was always no and no from residency but people seem to differ in that. thoughts?

 

[Instatewaiter]

i've noticed some variability in how these types of patients are managed at my hospital from various hospitalists in our group and never really realized that there would such differences

patient comes in with + blood and urine culture for instance enterococcus. repeat blood culture negative and no complications with patient. do you 1) send them out with IV abx and PICC line and 2) do they need an echo

for me, its was always no and no from residency but people seem to differ in that. thoughts?

Depends on the bug and depends on how quickly they clear. Not clearling for a few days should get an echo. SA should get an echo

 

[surge55]

What the above says. Usually you get 2 blood cultures the day of admission, then follow them. if positive, get 2 more. if the 2nd two are negative, then odds are you are treating it correctly. meanwhile, scale down antibiotic to something that can be switched to oral. as ISW said, 'usual' bugs should get Echo. but even then, I would say that if the next cultures are negative, it'd be really unlikely you developed vegetations. treat for 10-14 days depending on what it is (longer for osteomyelitis for example).

 

[obiwan]

i guess my thing is that if you have a urine culture with the same species with something like enterococcus which is one of the classic endo bugs, i wasn't getting echos just because the source is likely urinary

 

[Instatewaiter]

i guess my thing is that if you have a urine culture with the same species with something like enterococcus which is one of the classic endo bugs, i wasn't getting echos just because the source is likely urinary

It's not only that it has another source but can seed a valve, especially in someone at risk.

 

[Bostonredsox]

Staph aureus always gets an echo. Gram negative endocarditis is much less common and unless there is clinical suspicion of a veg an echo is not recommended by IDSA. Staph from anywhere can and will seed the valves via hematogenous spread. Always echo.

And if it's a FQ sensitive bug, the bioavailability of FQs is virtually 100%, no reason for PICCS and Iv antibiotics to complete therapy

 

[jdh71]

Staph aureus always gets an echo. Gram negative endocarditis is much less common and unless there is clinical suspicion of a veg an echo is not recommended by IDSA. Staph from anywhere can and will seed the valves via hematogenous spread. Always echo.

And if it's a FQ sensitive bug, the bioavailability of FQs is virtually 100%, no reason for PICCS and Iv antibiotics to complete therapy

We're talking about enterococcus bro

 

[jdh71]

No, I don't echo everyone just because they have bacteremia. Not even if it's staph. Lots of people get staph bacteremia, almost all of them don't get endocarditis.

 

[dozitgetchahi]

I just rotated on ID, and on that service anyone with bacteremia got PICC and IV abx for a total of 14 days (anything else was 'mismanagement', although I never saw them back that up with any literature).

 

[obiwan]

I just rotated on ID, and on that service anyone with bacteremia got PICC and IV abx for a total of 14 days (anything else was 'mismanagement', although I never saw them back that up with any literature).

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