Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

D. CategorizationPatients should be stratified before choosing the initial antibiotic by the severity ofinfection and whether they have come in from the community or likely have ahealthcare-associated infection. There are three general categories of patients:• Community-acquired, mild-to-moderate infection• Community-acquired, severe infection/immunocompromised/high-risk• Healthcare-acquiredE. Treatment by CategoryEach category of patient has specific organisms that should be targeted withantimicrobial therapy. Empiric coverage for each category takes into account therelative risk for resistant organisms. The following factors contribute to apatient’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 malignancy1. Community-acquired, mild-to-moderate infection• Cefoxitin• Metronidazole PLUS cefazolin, cefuroxime or ceftriaxone• Metronidazole PLUS ciprofloxacino Less desirable because Pseudomonas coverage is not needed• Piperacillin/tazobactam, ertapenem,* meropenem*o Less desirable due to excessively broad coverageo *- ID approval required• Moxifloxacin, tigecycline*o Less desirable due to excessively broad coverage unless severebeta-lactam allergyo *- ID approval required• Ampicillin/sulbactam, cefotetan and clindamycin are no longerrecommended• Yeast and Enterococcus coverage is not required