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Guidelines
Follow Up & Duration

Follow Up & Duration

Duration

In general if the line is removed and no complications short courses are preferred based on the organism(s) isolated

Duration is timed from first negative culture and/or date line removed

General Guidance:

  • Candida and uncomplicated staph (removable source): minimum 2 weeks from first negative blood culture
  • Complicated (e.g. endocarditis, osteomyelitis, unremovable source or bacteremia that persists more than 72 hours on appropriate therapy) require 6 weeks of therapy
  • Gram negative:
    • Pseudomonas: 2 weeks from negative blood cultures
    • Other: 10 to 14 days from negative blood cultures

Step Down

Deescalation: 

  • Antibiotics should be narrowed to target the isolated organism(s) where appropriate
  • Deescalation should be based on the blood culture result (i.e. do NOT narrow based on urine culture results if growing same organism in blood)
  • patients with positive cultures growing staphylococcus or enterococcus are generally NOT eligible for oral step down - consult ID physician or clinical pharmacist

When to Repeat Blood Cultures

Repeat blood cultures if any of the following apply:

  • Gram positive bacteremia
  • Bacteremia due to S. aureus or Candida
  • Known or suspected endocarditis
  • Fever, leukocytosis, or other signs of infection after 72 hr of antibiotics
  • Site of infection has limited antimicrobial penetration (e.g. abscess or joint space infection)
  • Presence of intravascular prosthetic devices
  • Unknown source of initial bacteremia