Blood culture

Generally in this case, you need to assess the clinical significance of both culture results before deciding on antibiotic therapy. Here’s how to approach it:

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1. Blood Culture: CONS

• Consider contamination: CONS are common skin contaminants in blood cultures, especially if only one set is positive.
• Evaluate the clinical picture:
  • If the patient has fever, leukocytosis, worsening symptoms, or an indwelling catheter, treat as a true bloodstream infection.
  • If the patient is clinically stable and has no risk factors for bacteremia, it may be a contaminant.
• Next steps:
  • Check if CONS is present in multiple blood culture sets.
  • Look for risk factors (immunosuppression, central lines, recent surgery).
  • If true infection is suspected, start vancomycin (or an alternative based on sensitivity).

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2. Sputum Culture: MDR Enterobacter (G-ve Bacilli)

• Likely a true pathogen given the pneumonia diagnosis.
• Multidrug resistance (MDR) requires targeted therapy.
• Next steps:
  • Review the antibiotic susceptibility report.
  • Consider the severity of pneumonia (ICU vs. ward patient).
  • Empirical options (before susceptibility results):
    • Carbapenems (e.g., meropenem, imipenem)
    • Fluoroquinolone (e.g., ciprofloxacin, levofloxacin)
  • If carbapenem resistant, use Ceftazidime-avibactam +/- aztreonam.
  • Colistin + carbapenem regimen is generally no longer recommended due to high risk and side effects.
  • If the patient is stable, wait for final susceptibility results before escalation.