Sepsis Without a Clear Focus

Septic shock-------- Pseudomonas spp., gram-negative enteric bacilli, Staphylococcus spp., Streptococcus spp. Vancomycin (plusGentamicin (5 mg/kg per day) plus eitherPiperacillin/tazobactam

or

Cefepime
Adjust treatment when culture data become available. Drotrecogin alfa (activated)a or low-dose hydrocortisone and fludrocortisoneb may improve outcome in patients with septic shock.
,

Overwhelming post splenectomy sepsis ---------------Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis Ceftriaxone plusVancomycin1 If a -lactam-sensitive strain is identified, vancomycin can be discontinued.

Babesiosis ---------Babesia microti (,B. divergens (Europe)