Sepsis in urology patients

exp date isn't null, but text field is

  1. Request review by senior member of urology team.
  2. Manage Sepsis 6.
  3. Send blood cultures.
  4. Review:
    • Has a gentamicin resistant bacteria been isolated in blood or urine in last 6 months? If so ask for advice.
    • Was gentamicin given for surgical antimicrobial prophylaxis? Consider discussing dosing with clinical pharmacist if patient received gentamicin as part of surgical prophylaxis.
    • Review wounds and consider swabs if signs of infection - follow  Post-operative wound infection assessmentif wound infection is felt likely.
  5. Start antibiotics as outlined below.

Required investigations

  • Send blood and urine cultures prior to starting antibiotics.
  • Review wounds and consider sending swabs if signs of infection.

Antibiotic recommendation

Recommended Antibiotic

 

Amoxicillin 1g every 8 hours IV

AND

Gentamicin use NHS Lothian Calculator on AMT intranet page

CONSIDER ADDITION OF

Metronidazole if bowel injury possible

  • 400mg every 8 hours orally if route available
  • 500mg every 8 hours IV
Penicillin allergy

Vancomycin use NHS Lothian Calculator on AMT intranet page

AND

Gentamicin use NHS Lothian Calculator on AMT intranet page

CONSIDER ADDITION OF

Metronidazole if bowel injury possible

  • 400mg every 8 hours orally if route avaialble
  • 500mg every 8 hours IV

 

48-72 hour review

At 48-72 hours review the need for ongoing antibiotics & review microbiology results

Is the patient improving?

NO, ask for advice.

YES, review questions below:

  • Has an AKI developed whilst in hospital (AKI = x1.5 rise in creatinine from baseline)?
  • Has the patient developed gentamicin toxicity (hearing loss or disturbed balance)?
  • Has the patient grown gentamicin-resistant organisms?

If the answer is "Yes" to any of these questions ask for advice.

If the answer is “No” to all these questions and IV antibiotics are still required, continue gentamicin up to Day 5.

At day 5 review the patient and the antibiotic plan:

  • Is IV to oral switch possible?
  • If not, ask for advice.

Gentamicin is associated with irreversible hearing loss and balance problems; only continue regimens containing gentamicin past 5 days on recommendation from Microbiology/Infectious Diseases.