Effect of rapid cefpodoxime disk screening for early detection of third-generation cephalosporin resistance in Escherichia coli and Klebsiella pneumoniae bacteremia

Table 2 Antimicrobial prescription protocol for suspected bacteremia caused by Enterobacterales

Cases	Recommendations
Antimicrobials administered
Carbapenems, TAZ/PIPC, TAZ/CTLZ	Continuation of antimicrobials
Aminoglycoside	Continuation of antimicrobials If not urinary tract infection, change to 3rd generation cephalosporins If deemed necessary by the anaerobic activity, change to cephamycins, oxacefems, or TAZ/PIPC However, in severe cases such as septic shock, change to carbapenems
SBT/ABPC, Cephamycins, Oxacephems	Continuation of antimicrobials. ^a However, in severe cases such as septic shock, change to carbapenems
Cephalosporins (excluding Cephamycins and Oxacefems), quinolones	Continuation of antimicrobials. ^a If deemed necessary by the anaerobic activity, combine with MNZ or change to cephamycins, oxacefems, or TAZ/PIPC However, in severe cases such as septic shock, change to carbapenems
Other antimicrobial agents	Change to 3rd generation cephalosporins If deemed necessary by the anaerobic activity, change to 3rd generation cephalosporins plus MNZ, cephamycins, oxacefems, or TAZ/PIPC However, in severe cases such as septic shock, change to carbapenems
No antimicrobials administered	Initiate 3rd generation cephalosporins If deemed necessary by the anaerobic activity, initiate cephamycins, oxacefems, or TAZ/PIPC However, in severe cases such as septic shock, initiate carbapenems

TAZ/PIPC Tazobactam/piperacillin, TAZ/CTLZ Tazobactam/ceftolozane, SBT/ABPC Sulbactam/ampicillin, MNZ Metronidazole
^aIf the bacterial species are identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry and intrinsic resistance to the administered antimicrobial agent is evident, change to an effective antimicrobial agent is suggested

ISSN: 2055-0294