Hospital Associated Infections

Enterobacter cloacae

a lactose-fermenting, gram-ve rod characterized by extensive antibiotic resistance.

associated with nosocomial UTIs, pneumonia and surgical site infections.

Antimicrobial Resistance (AMR)

Antibiotic Stewardship

General Recommendations:

• prescribe an antibiotic only when there is likely to be clear clinical benefit, giving alternative, non-antibiotic self-care advice, where appropriate
• if a person is systemically unwell with symptoms or signs of serious illness or is at high risk of complications: give immediate antibiotic. Always consider possibility of sepsis and escalate as appropriate
• use a lower threshold for antibiotics in immunocompromised people, or in those with multiple morbidities; consider culture/specimens and seek advice.
• take timely microbiological samples where advised based on local and national policies
• use local antimicrobial guidelines to initiate empirical treatment
• where an empirical therapy has failed or special circumstances exist, obtain microbiological advice.
• limit prescribing over the telephone to exceptional cases
• use simple, generic antibiotics if possible. Avoid broad spectrum antibiotics (for example, co-amoxiclav, quinolones and cephalosporins) when narrow spectrum antibiotics remain effective, as they increase the risk of Clostridioides difficile, MRSA and resistant UTIs
• avoid widespread use of topical antibiotics, especially in those agents also available systemically (for example, fusidic acid); in most cases, topical use should be limited.
• always check for antibiotic allergies
• document indication for treatment, dose and duration in clinical notes
• avoid use of quinolones unless benefits outweigh the risk.