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D. Categorization
Patients should be stratified before choosing the initial antibiotic by the severity of
infection and whether they have come in from the community or likely have a
healthcare-associated infection. There are three general categories of patients:
Community-acquired, mild-to-moderate infection
Community-acquired, severe infection/immunocompromised/high-risk
E. Treatment by Category
Each category of patient has specific organisms that should be targeted with
antimicrobial therapy. Empiric coverage for each category takes into account the
relative risk for resistant organisms. The following factors contribute to a
patient’s being “high-risk.”
Clinical Factors Predicting Failure of Source Control
• Delay in initial intervention >24 hours
• High degree of severity of illness (defined as APACHE II score >15)
• Increasing age
• Comorbidities and organ dysfunction
• Low serum albumin
• Poor nutritional status
• Degree of peritoneal involvement or diffuse peritonitis
• Inability to achieve adequate debridement or control of drainage
• Presence of malignancy
1. Community-acquired, mild-to-moderate infection
Metronidazole PLUS cefazolin, cefuroxime or ceftriaxone
Metronidazole PLUS ciprofloxacin
o Less desirable because Pseudomonas coverage is not needed
Piperacillin/tazobactam, ertapenem,* meropenem*
o Less desirable due to excessively broad coverage
o *- ID approval required
Moxifloxacin, tigecycline*
o Less desirable due to excessively broad coverage unless severe
beta-lactam allergy
o *- ID approval required
Ampicillin/sulbactam, cefotetan and clindamycin are no longer
Yeast and Enterococcus coverage is not required