Patient handout

Sepsis acquisition bridge — community (CAS) vs healthcare-associated (HCA/HAP)

PRODUCTION

1. Your condition

This handout is for sepsis acquisition bridge — community (cas) vs healthcare-associated (hca/hap). Your care team identified this based on: sepsis recognised by id.sepsis.core.v1 (qsofa ≥ 2 / sofa delta ≥ 2 / suspected infection) — bridge fires to phenotype acquisition + select empiric breadth (ssc 2026; singer sepsis-3 jama 2016 pmid 26903336).

Other reasons your team may use this plan: hospital day ≥ 48 since admission + new sepsis features → hca acquisition phenotype gate (cdc nhsn definitions; rhee jama 2017); qualifying hca exposure within 90 d (recent hospitalization ≥ 2 d / snf / ltac / dialysis / iv chemo / wound care / functional dependence) — hca acquisition phenotype (friedman ann intern med 2002); prior mdro isolate documented (mrsa / esbl / cre / cr-acinetobacter / vre) — high-mdr-risk tier + targeted empirics (idsa amr 2024 tamma).

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
piperacillin-tazobactam	4.5 g IV q6-8 h (extended infusion 4 h preferred); first dose within 1 h of recognition	IV	q6-8h extended infusion	SSC 2026 + IDSA/ATS 2016 Kalil — broad Gram-negative including Pseudomonas + anaerobes; appropriate community sepsis empirics when no qualifying HCA risk factors; pneumococcal + streptococcal + community E. coli + community S. aureus coverage adequate
ceftriaxone	1-2 g IV q24h; 2 g if CNS source or severe	IV	daily	Alternative to pip-tazo for non-Pseudomonal community sepsis; combine with metronidazole if anaerobic coverage needed (intra-abdominal / aspiration pneumonia)
metronidazole	500 mg IV q8h	IV	q8h	Anaerobic coverage when ceftriaxone used instead of pip-tazo (SSC 2026)
vancomycin	15-20 mg/kg IV q8-12h; target AUC 400-600 (Rybak IDSA 2020 PMID 32191793)	IV	q8-12h	Add vancomycin only when CA-MRSA risk factors present (IDU, chronic dialysis, recent hospitalization, prison contact, athletes); avoid routine vancomycin in low-MDR CAS to limit stewardship pressure

Plan: Sepsis empiric antibiotic breadth — by acquisition phenotype (CAS vs HCA) + MDR risk tier

3. When to call your provider

Contact your care team if any of the following happen:

New fever / chills / line-site infection during OPAT → ED for recurrent bacteremia workup
Drug-interaction event (rhabdomyolysis on statin + daptomycin, INR elevation on rifampin, serotonin syndrome on linezolid + SSRI) → adjust per DDI rules + safety consult
Line dysfunction → IR or vascular consult; consider line removal + alternative access
New MDRO isolate in outpatient cultures → ID urgent + IPC notification
PHQ-9 ≥ 15 OR suicidal ideation → mental health urgent referral (parent)

4. When to seek emergency care

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

HCA sepsis (≥ 48 h post-admission OR qualifying HCA exposure within 90 d) WITH high MDR risk (prior abx 90 d OR documented MDRO colonisation OR ICU > 7 d OR local antibiogram > 10 % MDR) — severe; broaden empirics to include anti-Pseudomonal β-lactam + anti-MRSA + ESBL/CRE coverage as documented; ID consult + local antibiogram review (IDSA/ATS 2016 Kalil PMID 27418577; IDSA AMR 2024 Tamma; Rhee JAMA 2017)
CAS — sepsis recognised < 48 h post-admission AND no qualifying HCA exposure within 90 d AND no documented MDRO — severe; narrower empirics adequate (pip-tazo OR ceftriaxone+metronidazole by source; vancomycin only if CA-MRSA risk); avoid over-broad empirics to limit stewardship pressure (SSC 2026; IDSA/ATS 2016 Kalil)
Prior systemic antibiotic exposure within 90 d in patient with new sepsis features — severe; LR+ ~ 2-3 for MDRO infection; empiric breadth escalation; ESBL + MRSA likely; consider carbapenem at start if critically ill + prior broad β-lactam (IDSA/ATS 2016 Kalil PMID 27418577; IDSA AMR 2024 Tamma)
Documented prior MDRO colonisation (MRSA nares / ESBL stool / CRE rectal / VRE / VRSA) — severe; LR+ ~ 8-10 for same MDRO in current episode (strongest single risk modifier); target empirics to documented organism + susceptibility from start (IDSA AMR 2024 Tamma; CDC/HICPAC 2024)
Sepsis in patient on chronic hemodialysis OR with indwelling central line OR with implanted vascular device — life-threatening; MRSA + Pseudomonas + Candida coverage; differential time-to-positivity blood culture if line present; line removal evaluation per Mermel; routes to id.crbsi.core.v1 if line-related (Mermel IDSA 2009 PMID 19489710; AHA Baddour 2015 endocarditis)(life-threatening)
Surgically / interventionally / drainable source identified but NOT addressed within 6-12 h of sepsis recognition (abscess, perforation, obstruction, infected device) — severe; failure to source-control by 12 h triples in-hospital mortality (SSC 2026 strong recommendation — independent mortality determinant)

5. Follow-up

OPAT post-discharge if IV-only therapy remaining (endocarditis 6 wk, osteomyelitis 6 wk, organ-space SSI extended); outpatient ID follow-up at 1-2 wk; antimicrobial stewardship feedback to discharging unit; vaccination review (PCV20, influenza, COVID-19, herpes zoster per ACIP 2024); PICS screen at 1-3 months per parent engine.

6. Sources

Guideline: Surviving Sepsis Campaign 2026 (Evans CCM 2026 + Intensive Care Med 2026) + SSC 2021 (Evans CCM 2021) + IDSA/ATS 2016 HAP/VAP guideline (Kalil PMID 27418577) + Mermel IDSA 2009 CRBSI guideline (PMID 19489710) + IDSA AMR 2024 MDRO guidance (Tamma) + IDSA candidiasis 2016 (Pappas PMID 26679628) + Sepsis-3 (Singer JAMA 2016 PMID 26903336) + Kumar CCM 2006 (PMID 16625125) + Rhee JAMA 2017 + Friedman Ann Intern Med 2002 (PMID 11926586 — HCA-bacteremia phenotype) + Wisplinghoff CID 2004 (PMID 15306996 — SCOPE nosocomial BSI epidemiology) + Rybak IDSA 2020 vancomycin AUC (PMID 32191793) + CREDIBLE-CR Bassetti Lancet Infect Dis 2021 + APEKS-NP Wunderink Lancet Infect Dis 2021 + ATTACK Kaye 2023 + van Duin Lancet Infect Dis 2018