Sepsis and Catheter-Related Bloodstream Infections Clinical Practice Guidelines (JAID/JSC, 2021)

Japanese Association for Infectious Diseases/Japanese Society of Chemotherapy

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

February 26, 2021

Guidelines on the treatment of sepsis and catheter-related bloodstream infections were published in February 2021 by the Japanese Association for Infectious Diseases/Japanese Society of Chemotherapy in Journal of Infection and Chemotherapy.[1]

Treatment of sepsis in adults

Third-generation cephalosporins are recommended for patients with severe community-acquired sepsis. Carbapenems are recommended for those at high risk for infection with extended-spectrum beta-lactamase–producing bacteria. Consider combination therapy with vancomycin for patients with suspected Streptococcus pneumoniae infection.

For adults with nosocomial sepsis, consider combination therapy with beta-lactam antibiotics and agents active against methicillin-resistant Staphylococcus aureus (MRSA). Drug selection should be guided by institutional antibiograms. Consider antifungal drugs for patients with severe sepsis and those with neutropenia/immunodeficiency.

Treatment of sepsis in children

For patients with community-acquired sepsis, administer cefotaxime or ceftriaxone as empiric therapy. Add vancomycin to the regimen in areas where S aureus infection is common.

For children with nosocomial sepsis, select drugs on the basis of the regional prevalence of infections, the site of onset (community or hospital), underlying conditions, and risk factors (eg, medical devices, neutropenia).

Treatment of sepsis in neonates

For patients with early-onset sepsis, administer an empiric regimen that includes ampicillin and gentamicin or ampicillin and cefotaxime. For those with late-onset sepsis, the selection of empiric therapy is guided by institutional and regional antibiograms.

Treatment of catheter-related bloodstream infections

For adults, empiric combination therapy should include anti-MRSA agents and broad-spectrum antibiotics.

For children, empiric therapy should include vancomycin and third- or fourth-generation cephems or carbapenems. Antifungal agents are recommended for patients on total parenteral nutrition, those receiving long-term broad-spectrum antimicrobial therapy, those with hematologic malignancies, and those who underwent transplantation, as well as patients with fungal infections.

For more information, please go to Bacterial Sepsis.

For more Clinical Practice Guidelines, please go to Guidelines.

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