Patient selection: febrile neutropenia
Indications for addition of antibiotic coverage for Gram-positive bacteria:
(1) severe sepsis (hemodynamic instability, etc)
(2) pneumonia seen on imaging studies
(3) positive blood culture for a Gram-positive bacteria prior to speciation
(4) clinical evidence for a serious intravascular catheter-associated infection (cellulitis around the catheter, pus, chills or rigors with infusion, etc)
(5) soft tissue infection of any site
(6) skin infection of any site
(7) colonization with a antibiotic-resistant Gram-positive bacteria
(8) severe mucositis (if fluoroquinolone used for prophylaxis and if ceftazidime used as empiric therapy)
where:
• Antibiotic resistant Gram-positive bacteria may include: methicillin-resistant Staphylococcus aureus (MRSA), penicillin-resistant Streptococcus pneumoniae (PRSP), vancomycin-resistant enterococcus (VRE).
