Patient handout

Hospital-acquired infection (HAI) overlay — CLABSI / CAUTI / VAP-HAP / CDI / SSI

PRODUCTION

1. Your condition

This handout is for hospital-acquired infection (hai) overlay — clabsi / cauti / vap-hap / cdi / ssi. Your care team identified this based on: new fever, hypotension, leukocytosis, or sepsis features > 48 h after hospital admission — hai screen + hca-acquisition flag (cdc/hicpac 2024 nhsn definitions).

Other reasons your team may use this plan: central venous catheter in situ + new fever / bacteremia — clabsi workup (mermel idsa 2009 pmid 19489710); urinary catheter in situ + dysuria / suprapubic pain / fever / pyuria — cauti workup (cdc gould 2009 pmid 20156062; idsa hooton 2010); mechanical ventilation ≥ 48 h + new / progressive infiltrate + purulent secretions + fever / leukocytosis / hypoxemia — vap workup (idsa/ats 2016 kalil pmid 27418577).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
vancomycin	15-20 mg/kg IV q8-12h; target AUC 400-600 (Rybak IDSA 2020 PMID 32191793)	IV	q8-12h	Empiric anti-MRSA / CoNS cover until cultures; AUC-target preferred over trough
cefepime	2 g IV q8h (extended infusion 3-4 h preferred)	IV	q8h	Empiric anti-Pseudomonal Gram-negative cover; extended infusion improves PK target attainment (Mouton)
meropenem	1 g IV q8h (2 g if meningitis or critically ill)	IV	q8h	ESBL cover when local resistance pattern + prior abx exposure suggests ESBL Enterobacterales (MERINO trial Harris JAMA 2018)
caspofungin	70 mg IV load × 1 then 50 mg IV daily	IV	daily	Empiric anti-fungal for candidemia in high-risk CLABSI (IDSA candidiasis 2016 Pappas PMID 26679628); routes to id.candidemia.core.v1
daptomycin	8-10 mg/kg IV q24h (higher dose for bacteremia / endocarditis)	IV	daily	High-dose daptomycin for VRE / persistent MRSA bacteremia / vancomycin failure; CPK monitoring weekly

Plan: HAI empiric antibiotics — by site (CLABSI / CAUTI / VAP-HAP / CDI / SSI) × MDRO pattern

3. When to call your provider

Contact your care team if any of the following happen:

Recurrence of HAI features → ED + cultures + ID urgent consult
New MDRO isolate in outpatient cultures → ID + IPC notification
≥ 2 CDI recurrences → FMT referral

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Central-line-associated bloodstream infection with repeat positive blood cultures > 72 h despite line removal + appropriate empiric antibiotics — life-threatening; rules out endocarditis + endovascular complications (Mermel IDSA 2009 PMID 19489710; AHA Baddour 2015 endocarditis)(life-threatening)
Fulminant CDI: ileus / megacolon / shock / WBC > 35 K / lactate ≥ 5 / Cr ≥ 2× baseline — life-threatening; IV metronidazole + high-dose oral / rectal vancomycin + emergent surgical evaluation (IDSA/SHEA 2017 McDonald + 2021 Johnson update; Neal Ann Surg 2011 surgical strategy)(life-threatening)
Ventilator-associated pneumonia with documented MDR pathogen (ESBL / CRE / CR-Acinetobacter / VRSA / MBL-producing) — life-threatening; ID + targeted regimen per susceptibility; lung-protective ventilation; source control if abscess (IDSA/ATS 2016 Kalil PMID 27418577; IDSA AMR 2024 MDRO guidance)(life-threatening)
Deep incisional or organ-space SSI: fever + wound drainage / dehiscence / abscess / anastomotic leak post-operatively ≤ 30 d (≤ 90 d if prosthetic implant) — severe; surgical re-exploration + broad-spectrum empiric + culture-directed; orthopedic implant infection → 6 wk IV + biofilm-active agents (IDSA/SHEA 2017 Berríos-Torres Zimmerli NEJM 2004 device infection)
Confirmed carbapenem-resistant Enterobacterales (CRE) OR carbapenem-resistant Acinetobacter OR VRSA OR pan-drug-resistant Gram-negative isolated from any HAI site — life-threatening; ceftazidime-avibactam OR meropenem-vaborbactam OR cefiderocol OR sulbactam-durlobactam + ID consult + contact precautions + IPC outbreak investigation (IDSA AMR 2024 MDRO guidance; CDC/HICPAC 2024)(life-threatening)
Catheter-associated UTI in critically ill / septic patient — severe; remove urinary catheter ASAP (or replace if catheter needed for monitoring) + culture-directed therapy; routes to id.pyelonephritis.core.v1 if upper-tract involvement (CDC Gould 2009 PMID 20156062; IDSA Hooton 2010)
Sepsis features (qSOFA ≥ 2 OR SOFA delta ≥ 2 OR hypotension on adequate fluids OR lactate ≥ 4) developing > 48 h after hospital admission — life-threatening; broad-spectrum empirics per local antibiogram + source control evaluation + routes to id.sepsis.core.v1 with HCA-acquisition flag (SSC 2026 Hour-1 bundle; IDSA/ATS 2016 Kalil)(life-threatening)

5. Follow-up

Outpatient ID follow-up for endocarditis / osteomyelitis / MDRO; OPAT coordination for extended-duration IV therapy; antimicrobial stewardship feedback to the unit; infection control investigation for clusters / outbreaks (≥ 3 of same MDRO in 1 unit / 1 month); patient + family education on recurrence; vaccination review (PCV20, influenza, COVID-19, herpes zoster per ACIP 2024); FMT referral for ≥ 2 CDI recurrences.

6. Sources

Guideline: CDC/HICPAC HAI guidance + NHSN 2024 definitions (CLABSI, CAUTI, VAE/VAP, CDI, SSI) + IDSA/ATS 2016 HAP/VAP guideline (Kalil PMID 27418577) + Mermel IDSA 2009 CRBSI guideline (PMID 19489710) + IDSA/SHEA 2017 SSI prevention (Berríos-Torres) + IDSA/SHEA 2017 CDI guideline (McDonald) + IDSA/SHEA 2021 CDI focused update (Johnson — fidaxomicin first-line) + CDC Gould 2009 CAUTI prevention (PMID 20156062) + IDSA Hooton 2010 CAUTI diagnosis and management + IDSA AMR 2024 MDRO guidance + SSC 2026 sepsis bundle + IDSA/SHEA ASP 2016 antimicrobial stewardship framework