Standard regimen for hospital-acquired sepsis without septic shock in adults
In adults with hospital-acquired sepsis of unknown source without septic shock, antimicrobial choice depends on whether methicillin-resistant Staphylococcus aureus (MRSA) is suspected and whether the patient is at risk of invasive Candida infection. If the patient is at risk of invasive Candida infection, consider the addition of an antifungal.
For adults with hospital-acquired sepsis of unknown source without septic shock, in the absence of local protocols or advice, useAbdul-Aziz, 2024Dulhunty, 2024:
PLUS if the patient has suspected line-related sepsis, the hospital has a significant rate of nosocomial MRSA infection, or the patient has other risk factors for MRSA infection
vancomycin 25 mg/kg (actual body weight) rounded up to nearest 125 mg, up to 3 g intravenously, as a loading dose. See Calculated vancomycin loading dosage in critically ill adults for calculated weight-based loading doses. Subsequent doses are dependent on weight and kidney function; see Intermittent vancomycin dosing for critically ill adults. vancomycin vancomycin vancomycin
This empirical regimen is intended for initial therapy only (up to 48 hours). Modify therapy as soon as additional information is available (eg source of infection, results of Gram stain, culture and susceptibility testing). Evaluate the appropriateness of antimicrobial therapy daily, with consideration given to the patient’s clinical status and the principles of antimicrobial stewardship.
Cefepime is a reasonable alternative to piperacillin+tazobactam; some centres may prefer to use cefepime for the empirical treatment of hospital-acquired sepsis. For an appropriate cefepime regimen, see Penicillin hypersensitivity regimens for hospital-acquired sepsis without septic shock in adults.