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id.sepsis-bridge.community-vs-nosocomial.v1PRODUCTION
id.sepsis-bridge.community-vs-nosocomial.v1

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

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Canonical 12-phase frame with authored status for this dossier.

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Detailed

Bridge overlay framing: layered on top of id.sepsis.core.v1; sepsis recognised in parent; bridge fires to classify acquisition phenotype (CAS vs HCA) and select empiric breadth.

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Acquisition phenotype gate evaluated

Patient inputs (23)

Friedman HCA criterion 1 — hospitalisation ≥ 2 d in past 90 d shifts pathogen priors toward HCA pattern (Friedman Ann Intern Med 2002)

Friedman HCA criterion 2 — SNF / LTAC residence past 90 d → LR+ ~ 4 for MRSA + ~ 3 for Pseudomonas (Friedman 2002 + Wisplinghoff CID 2004 PMID 15306996)

Friedman HCA criterion 3 — chronic dialysis → LR+ ~ 4 MRSA + ~ 6 catheter-related bacteremia (Mermel IDSA 2009)

Friedman HCA criterion 4 — IV chemo past 30 d → LR+ ~ 5 for fungal-coverage need (neutropenic fever IDSA 2024 + IDSA candidiasis 2016 Pappas PMID 26679628)

Friedman HCA criterion 5 — functional dependence → LR+ ~ 2 for MDRO (Friedman Ann Intern Med 2002)

Prior systemic antibiotic exposure within 90 d → LR+ ~ 2-3 for MDRO infection; shifts CAS pathogen priors toward HCA pattern; carbapenem threshold trigger when combined with critically-ill (IDSA/ATS 2016 Kalil PMID 27418577 + IDSA AMR 2024)

Documented MDRO colonisation (MRSA nares / ESBL stool / CRE rectal / VRE) → LR+ ~ 8-10 for same MDRO in current episode; strongest single risk modifier; targeted empirics from start (IDSA AMR 2024 Tamma)

ICU > 7 d → higher MDR Gram-negative + fungal + C. auris risk; drives empiric broadening + antifungal-add (IDSA/ATS 2016 Kalil)

IDU → LR+ ~ 6 for S. aureus bacteremia (community-acquired-MRSA in IDU cohorts) + ~ 4 for right-sided endocarditis (AHA Baddour 2015)

CVC in situ → CRBSI workup; tunneled vs non-tunneled drives line-removal threshold (Mermel IDSA 2009 PMID 19489710)

Fever > 38 °C or hypothermia < 36 °C are sepsis screening features; passed through from parent (SSC 2026)

Hospital day ≥ 48 since admission is the canonical CDC NHSN HCA-onset threshold; informs acquisition phenotype gate (Rhee JAMA 2017)

Leukocytosis / leukopenia tracks sepsis severity + infection extent

Two sets from separate sites BEFORE antibiotics if no delay > 45 min (SSC 2026); differential time-to-positivity > 2 h between line vs peripheral supports CRBSI (Mermel IDSA 2009)

Hypotension drives septic-shock phenotype + ICU disposition (parent engine SSC 2026 Hour-1 bundle)

Lactate > 2 → resuscitation; > 4 → septic shock physiology (parent engine SSC 2026 Hour-1 bundle)

Local resistance > 10% to monotherapy drives empiric vancomycin or carbapenem decision (IDSA/ATS 2016 Kalil)

Cr drives renal-dose adjustment of vancomycin / aminoglycosides / β-lactams + cefepime neurotoxicity threshold (Rybak IDSA 2020 PMID 32191793; cefepime label)

β-D-glucan ≥ 80 pg/mL in HCA patient with Candida risk factors → empiric echinocandin trigger; serum mannan + anti-mannan + β-D-glucan combination raises specificity (IDSA candidiasis 2016 Pappas)

TEE for persistent S. aureus / Enterococcus / Candida bacteremia > 72 h or with risk factors; rules out endocarditis (AHA Baddour 2015)

MRSA nares + ESBL stool + CRE rectal + VRE swab — drives targeted empirics for documented colonisation (CDC/HICPAC 2024)

Adjunct for de-escalation in HCA pneumonia (decrease ≥ 80% over 5-7 d supports stop); not for initiation decisions (IDSA/ATS 2016 Kalil + ProGUARD-ICU 2021)

TPN + broad abx > 7 d + ICU > 7 d + abdominal surgery + central line → antifungal-add decision (IDSA candidiasis 2016 Pappas PMID 26679628)

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Severity triggers (8)

8 need judgement
  • informationallife_threateningdialysis_or_indwelling_line_sepsis
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverehca_sepsis_with_high_mdro_risk
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverecas_sepsis_no_hca_risk_factors
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereprior_antibiotic_exposure_90d
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereprior_mdro_colonization_documented
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveresource_not_controlled_at_6_12h
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatelocal_antibiogram_drives_empiric_breadth
    Local institutional antibiogram review identifies > 10 % local MRSA prevalence (drives empiric vancomycin add) OR > 10 % local ESBL Enterobacterales prevalence (drives carbapenem add for HCA empirics in critically ill / prior abx 90 d) — moderate; antibiogram-driven empiric selection is the IDSA-recommended approach (IDSA/ATS 2016 Kalil PMID 27418577; IDSA AMR 2024 Tamma)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmildde_escalation_at_48_72h
    Culture results + clinical improvement at 48-72 h — mild; culture-driven narrowing per organism + susceptibility; stop vancomycin if no MRSA / Enterococcus; stop antipseudomonal if no Pseudomonas; IV-to-PO step-down when tolerating PO; document duration plan (IDSA/SHEA ASP 2016 stewardship)
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Sepsis empiric antibiotic breadth — by acquisition phenotype (CAS vs HCA) + MDR risk tier
axis: sepsis_empiric_breadth_by_acquisitionstep cas_empiric - CAS — community-acquired sepsis empirics (narrower)
Selected step "CAS — community-acquired sepsis empirics (narrower)" — Sepsis recognised < 48 h after admission AND no qualifying HCA exposure within 90 d AND no documented MDRO colonisation
  • piperacillin-tazobactam
    first line
    penicillin_BLI
    4.5 g IV q6-8 h (extended infusion 4 h preferred); first dose within 1 h of recognition • IV • q6-8h extended infusion
    triggers: cas_recognition, unknown_source, no_severe_pcn_allergy
    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
    rxcui 74169
  • ceftriaxone
    second line
    cephalosporin_3rd
    1-2 g IV q24h; 2 g if CNS source or severe • IV • daily
    triggers: cas_with_known_source_amenable_to_narrower_cover, no_pseudomonas_risk
    Alternative to pip-tazo for non-Pseudomonal community sepsis; combine with metronidazole if anaerobic coverage needed (intra-abdominal / aspiration pneumonia)
    rxcui 2193
  • metronidazole
    add on
    nitroimidazole
    500 mg IV q8h • IV • q8h
    triggers: ceftriaxone_chosen_with_anaerobic_source, intra_abdominal_or_aspiration
    Anaerobic coverage when ceftriaxone used instead of pip-tazo (SSC 2026)
    rxcui 6922
  • vancomycin
    comorbidity specific
    glycopeptide
    15-20 mg/kg IV q8-12h; target AUC 400-600 (Rybak IDSA 2020 PMID 32191793) • IV • q8-12h
    triggers: ca_mrsa_risk_idu_dialysis_recent_hospitalization, severe_sstis_with_purulence, severe_cap_with_post_influenza
    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
    rxcui 11124

outpatient playbook — drug actions (4)

  1. 1. OPAT IV continuation
    Per agent (typical: ceftriaxone 1-2 g IV daily, daptomycin 6-8 mg/kg IV daily, ertapenem 1 g IV daily, cefepime 2 g IV q12h, vancomycin q12-24h) • IV (PICC) • per agent
    trigger: IV-only therapy remaining + OPAT-eligible
    IDSA OPAT Norris 2018
  2. 2. PO antibiotic continuation if course ongoing
    Per agent + indication (linezolid 600 mg PO q12h for MRSA; levofloxacin 750 mg PO daily for susceptible Gram-negative; TMP-SMX for UTI / MSSA SSTI; doxycycline for MRSA SSTI) • PO • per agent
    trigger: Discharge with PO course remaining
    Complete course; do not stop early
  3. 3. Vaccination administration
    Per ACIP age + indication (PCV20 0.5 mL IM × 1; influenza annual; COVID-19 per current ACIP; Shingrix 0.5 mL IM × 2 if ≥ 50 or ≥ 19 with immunocompromise) • IM • per ACIP
    trigger: Vaccination status review identifies gaps
    Reduce future HAI risk + improve overall immunisation (parent SSC 2026 + ACIP 2024)
  4. 4. Restore home chronic regimen (parent pass-through)
    per patient baseline • PO • per agent
    trigger: Stable post-discharge, no contraindication
    Avoid medication-list drift; reconcile additions/holds from acute care (parent SSC 2026)

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: 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); 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).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Sepsis acquisition bridge — community (CAS) vs healthcare-associated (HCA/HAP)** (id.sepsis-bridge.community-vs-nosocomial.v1).
Phenotype framing: Phenotype the acquisition tier — CAS (< 48 h post-admission + no qualifying HCA exposure) vs HCA-ward (≥ 48 h ward) vs HCA-ICU (≥ 48 h ICU + higher MDR burden); within HCA, MDRO risk tier — low / moderate / high / ESBL-suspected / CRE-suspected. Host modifier — immunocompetent / immunocompromised / dialysis / chronic-wound / IDU.
Scope: Bridge overlay framing: layered on top of id.sepsis.core.v1; sepsis recognised in parent; bridge fires to classify acquisition phenotype (CAS vs HCA) and select empiric breadth.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Sepsis empiric antibiotic breadth — by acquisition phenotype (CAS vs HCA) + MDR risk tier** — step "CAS — community-acquired sepsis empirics (narrower)".
1. 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 (penicillin_BLI, first line) — 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
2. ceftriaxone 1-2 g IV q24h; 2 g if CNS source or severe IV daily (cephalosporin_3rd, second line) — Alternative to pip-tazo for non-Pseudomonal community sepsis; combine with metronidazole if anaerobic coverage needed (intra-abdominal / aspiration pneumonia)
3. metronidazole 500 mg IV q8h IV q8h (nitroimidazole, add on) — Anaerobic coverage when ceftriaxone used instead of pip-tazo (SSC 2026)
4. vancomycin 15-20 mg/kg IV q8-12h; target AUC 400-600 (Rybak IDSA 2020 PMID 32191793) IV q8-12h (glycopeptide, comorbidity specific) — 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

Setting playbook (outpatient) — OPAT continuation for IV-only remaining therapy (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; PICS surveillance per parent
5. OPAT IV continuation Per agent (typical: ceftriaxone 1-2 g IV daily, daptomycin 6-8 mg/kg IV daily, ertapenem 1 g IV daily, cefepime 2 g IV q12h, vancomycin q12-24h) IV (PICC) per agent — IV-only therapy remaining + OPAT-eligible (IDSA OPAT Norris 2018)
6. PO antibiotic continuation if course ongoing Per agent + indication (linezolid 600 mg PO q12h for MRSA; levofloxacin 750 mg PO daily for susceptible Gram-negative; TMP-SMX for UTI / MSSA SSTI; doxycycline for MRSA SSTI) PO per agent — Discharge with PO course remaining (Complete course; do not stop early)
7. Vaccination administration Per ACIP age + indication (PCV20 0.5 mL IM × 1; influenza annual; COVID-19 per current ACIP; Shingrix 0.5 mL IM × 2 if ≥ 50 or ≥ 19 with immunocompromise) IM per ACIP — Vaccination status review identifies gaps (Reduce future HAI risk + improve overall immunisation (parent SSC 2026 + ACIP 2024))
8. Restore home chronic regimen (parent pass-through) per patient baseline PO per agent — Stable post-discharge, no contraindication (Avoid medication-list drift; reconcile additions/holds from acute care (parent SSC 2026))

Non-pharmacologic actions:
- Vascular / IR line coordination for OPAT PICC
- Home infusion + ID clinic visit at week 1 and week 2
- Patient + family education on line care, signs of recurrence, when to call OPAT/ID, when to return to ED
- Pulmonary rehab referral if mechanical ventilation ≥ 48 h (parent)
- Cognitive rehab if MoCA < 26 at first visit (parent)
- Mental health referral if PHQ-9 ≥ 10 or PCL-5 ≥ 31 (parent)
- Antimicrobial stewardship feedback to discharging unit (rotational + per-encounter)
- Caregiver support — PICS-Family (parent SSC 2026)

AVOID / contraindication checks:
- Hour_1_bundle_regardless_of_acquisition_phenotype (SSC 2026 + Kumar CCM 2006 PMID 16625125)
- Source control within 6 12h independent mortality determinant (SSC 2026 strong recommendation)
- Vancomycin AUC target not trough (Rybak IDSA 2020 PMID 32191793)
- Cefepime neurotoxicity in renal impairment dose adjust (cefepime label)
- Carbapenem reserve for documented ESBL or critically ill (IDSA/ATS 2016 Kalil)
- Antifungal add for Candida risk TPN broad abx ICU 7d (IDSA candidiasis 2016 Pappas PMID 26679628)
- Linezolid monitor platelets weekly and MAOI DDI (linezolid label + IDSA/SHEA)
- Daptomycin monitor cpk weekly and not for pneumonia (DAP PNX trial)
- Do not narrow empirics before 48 72h culture results (IDSA/SHEA ASP 2016)
- Procalcitonin de escalation only not initiation (SSC 2026 conditional + ProGUARD ICU 2021)
- Line removal strong for non tunneled with SA Pseudo Candida (Mermel IDSA 2009 PMID 19489710)
- Contact precautions for confirmed or suspected MDRO (CDC/HICPAC 2024)

Monitoring

Regimen monitoring:
- blood cultures repeat q24-48h until two consecutive negatives for S. aureus / Enterococcus / Candida bacteremia (Mermel IDSA 2009)
- vancomycin AUC q48-72h target 400-600 (Rybak IDSA 2020 PMID 32191793)
- daptomycin CPK weekly
- linezolid platelets weekly + serotonin-syndrome DDI screen
- procalcitonin trend for HCA pneumonia de-escalation (ProGUARD-ICU 2021 — ≥ 80% decrease over 5-7 d supports stop)
- culture-directed narrowing at 48-72 h (IDSA/SHEA ASP 2016 stewardship)
- local antibiogram review with ID stewardship at 72 h for HCA cases (IDSA/SHEA ASP 2016)
- TEE follow-up at 4-6 wk if endocarditis confirmed (AHA Baddour 2015)
- source control coordination within 6-12 h regardless of phenotype (SSC 2026 strong)

Setting (outpatient) monitoring:
- Weekly clinical + lab follow-up: CBC, BMP, LFT, vancomycin AUC, daptomycin CPK, linezolid platelets
- Monthly ID follow-up while on OPAT
- Quarterly follow-up for chronic complications (endocarditis, osteomyelitis, prosthetic implant infection)
- PCP visit within 7-14 days of discharge (parent)
- PICS screens at 1 + 3 months (parent)
- 30-day readmission risk monitoring (parent)
- Antibiotic completion confirmation if oral course extends past discharge (IDSA/SHEA ASP 2016 stewardship)

Follow-up plan: 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.
- Close-out criterion: OPAT + ID + stewardship + vaccination plans documented

Monitoring phase: Repeat blood cultures q24-48 h until 2 consecutive negatives for S. aureus / Enterococcus / Candida; procalcitonin trend for de-escalation in HCA pneumonia (ProGUARD-ICU 2021); vancomycin AUC q48-72 h (Rybak IDSA 2020); daily reassessment of antibiotic + duration per IDSA/SHEA ASP 2016 stewardship; culture-directed narrowing at 48-72 h.

Disposition

Current setting: outpatient — OPAT continuation for IV-only remaining therapy (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; PICS surveillance per parent

Disposition criteria:
- Completion: total duration met + clinical resolution + cultures negative → discharge from sepsis-bridge surveillance; return to parent post-sepsis surveillance (PICS screens at 1 + 3 months)
- Sustained recovery — no recurrence at 6 mo + immunosuppression stable + vaccinations up to date → discharge from HCA-specific surveillance back to standard primary care

Escalation triggers (move to higher acuity):
- 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)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] 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)
- [SEVERE] 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)
- [SEVERE] 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)

Citations

- 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 [PMID:34605781](https://pubmed.ncbi.nlm.nih.gov/34605781/)
- Cited evidence (PMID 16625125) [PMID:16625125](https://pubmed.ncbi.nlm.nih.gov/16625125/)
- Cited evidence (PMID 27418577) [PMID:27418577](https://pubmed.ncbi.nlm.nih.gov/27418577/)
- Cited evidence (PMID 19489710) [PMID:19489710](https://pubmed.ncbi.nlm.nih.gov/19489710/)
- Cited evidence (PMID 15306996) [PMID:15306996](https://pubmed.ncbi.nlm.nih.gov/15306996/)

Last reconciled with current guidelines: 2026-05-22.
References
  • 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 — PMID:34605781
  • Cited evidence (PMID 16625125) — PMID:16625125
  • Cited evidence (PMID 27418577) — PMID:27418577
  • Cited evidence (PMID 19489710) — PMID:19489710
  • Cited evidence (PMID 15306996) — PMID:15306996