Management of E. coli Bacteremia with Sepsis

Initial Management Approach

The American College of Critical Care Medicine recommends obtaining at least 2 sets of blood cultures before starting antimicrobial therapy if no significant delay will occur, and collecting one blood culture percutaneously and one through each vascular access device (unless inserted <48 hours prior) 2
The Society of Critical Care Medicine suggests performing appropriate imaging studies promptly to identify the source of infection 2
The Intensive Care Medicine society recommends administering effective intravenous antimicrobials within the first hour of recognition of septic shock (grade 1B) and severe sepsis without septic shock (grade 1C) 3, 1

The Critical Care Medicine society advises rapidly identifying and addressing the anatomical source of infection within 12 hours of diagnosis when feasible 2, 1
The Intensive Care Medicine society recommends removing potentially infected intravascular access devices promptly after establishing alternative access 2

The Critical Care Medicine society suggests reassessing antimicrobial regimen daily for potential de-escalation based on culture results 3, 1
The Society of Critical Care Medicine recommends considering procalcitonin levels to guide discontinuation of empiric antibiotics when no subsequent evidence of infection is found 3, 1
The Critical Care Medicine society advises that the duration of therapy typically is 7-10 days; longer courses may be needed for patients with slow clinical response or undrainable foci of infection 3