Care should be taken not to contaminate the venipuncture site after preparation and prior to phlebotomy.
#ANTIBIOTICS TO TREAT GRAM NEGATIVE RODS SKIN#
The proper technique for obtaining blood cultures requires thorough cleaning of the skin surface with 70% alcohol followed by iodine-based preparation or 0.5 % chlorhexidine for 1-2 minutes ( 19, 23). This chapter attempts to provide general recommendations for such a clinical situation. However, no guidelines exist regarding the initial selection of antibiotics based on the preliminary results of the Gram stain. The Infectious Diseases Society of America (IDSA) and other organizations have issued recommendations for the treatment of bacteremia in the context of catheter-related infections that include both empirical and specific organism-based treatment protocols. Until molecular techniques for detection of bacteria in blood cultures are more readily available and easier to implement ( 25, 31), clinicians will have to continue to rely on the Gram stain as the preliminary source of data for making empiric therapeutic decisions. The field of PCR-based detection of organism is rapidly becoming a helpful tool in the identification and diagnosis of blood-stream infections, especially those caused by Gram-positive cocci ( 25, 28, 33). Once an organism has been fully identified, the antibiotic selection can be modified. Because of the high morbidity and mortality associated with bacteremia, prompt evaluation and appropriate empiric antibiotic treatment are of paramount importance ( 3).
While patients with positive blood cultures may be bacteremic signifying a true infection, there is a subset of patients with positive blood cultures that are due to contamination and therefore does not indicate a true infection. Bacteria are only partially identified on Gram stain and speciation and susceptibility results will take an additional 24-48 hours after a culture is reported as positive. The appropriate selection of e mpiric antibiotic therapy for positive blood cultures is a complex and difficult decision.
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