The

Yale 20-Pocketcards

An5bio5cs

Sep5c shock: Sepsis + SBP < 90 mmHg despite

appropriate uid resuscita5on

Severe Sepsis: Evidence of end organ damage (MODS)

Tissue hypoperfusion: Lactate > 1mmol/L
Lungs: paO2/FiO2 <300
Renal: UOP < 0.5ml/kg/h or Cr 0.5mg/dL
Heme: Platelets <100,000/L INR > 1.5 aPTT > 60s
Liver: Total Bili > 4mg/dL

Rx: ICU admission

IV an5bio5cs, vasopressor ggt

SIRS

1. T >38oC or <36oC
2. HR > 90/min
3. RR >20/min or paCO2
<32 mmHg
4. WBC >12,000/L or
< 4000/L or > 10%
immature bands

Sepsis: Evidence of systemic infec5on

SIRS posi5ve (2/4)+ suspected/culture proven infec5on

Rx: Consider ICU admission

IV an5bio5cs and IVF
Local Infec5on but no evidence of systemic infec5on
Rx: Treatment on the ward
PO an5bio5cs

1. Macrolides
(Erythromycin,
Clarithromycin)
2. Tetracyclines
(tetracycline,
doxycycline)

The two As:

Anaerobes
Atypicals/Spirochetes

Penicillins
gram negaOve:
+ Unasyn/AugmenOn

Gram +

Fluoroquinolones

1. Clindamycin
(above Diaphragm)
2. Metronidazole
(below diaphragm)
3. Unasyn, Zosyn,
Meropenem
Cephalosporins
gram posiOve:
1st > 2nd >3rd

Gram -
Pseudomonas
ESBL

MRSA
1. Vancomycin
2. Linezolid
3. Clindamycin/Bactrim/Doxy

1. Cegazidime
2.Piperacillin/tazobactam
3. Meropenem

The Yale 20

The two As:

Anaerobes and Atypicals
Cipro/Moxi/ Levooxacin

Mycoplasma
Clamydia
Legionella

Augmen5n/Unasyn

Cegriaxone

Strep pneumoniae

H inuenzae

Gram +

CAP
1. Augmen5n/ Unasyn +
Erythromycin/ Doxycycline

2. Cegriaxone +
Erythromycin/ Doxycycline

3. Cipro/Moxi/Levooxacin

Gram -

Erythromycin
Clarithromycin
Doxycycline

The two As:

Anaerobes and Atypicals
Oral ora
(Aspira5on)

Cipro/Levooxacin
(Moxi not eec5ve against Pseudomonas
H inuenzae
E coli
Klebsiella

Strep pneumoniae

Gram +
MRSA
Vancomycin

HCAP

Gram -

1. Vancomycin +
Pseudomonas
Cegazidime + Metronidazole

2. Vancomycin +
1. Cegazidime
Piperacillin/tazobactam 2.Piperacillin/tazobactam

3. Meropenem
3. Vancomycin +
Levooxacin

The two As:

Anaerobes and Atypicals
Vancomycin

(for CTX resistant S.

pneumo

Cegriaxone

Cegriaxone

(for Pen resistant

S pneumo)

Strep pneumoniae (30-60%)

40% Pen resistant
10% CTX resistant
Listeria (5-10%) if > 50 yo or alcoholic

N. meningi5dis
(10-35%)
H inuenzae
(< 5%)

Meningi5s
Ampicillin

Gram +
MRSA

Post
procedure/
CSF shunt

Vancomycin

1. Vancomycin + Cegriaxone

2. If >50 yo or alcoholic:
Vancomycin +
Cegriaxone + Ampicillin

3. If Post procedure/CSF
shunt/Immunosuppressed:
Vancomycin + Cegazidime

Gram -
GNR +
Pseudomonas
Immunosup-
pressed Pt

Cegazidime

The two As:

Anaerobes and Atypicals
Cipro/Levooxacin
Cegriaxone
(also Bactrim , Nitrofurantoin)

Augmen5n/Unasyn

GNR:
E coli (80%), Proteus, Klebsiella

Enterococcus, Staph epi

( in complicated UTI)

UTI/Pyelo

Gram +

1. Uncomplicated UTI
Bactrim, FQ, Nitrofurantoin
3 days (5 days)

2. Complicated UTI/Pyelonephri5s
Cegriaxone, FQ, Unasyn
7 (outpa5ent)-14 days (inpa5ent)

Gram -

The Yale 20

The two As:

Anaerobes and Atypicals
mild

moderate

severe
Anaerobes and Gram
nega5ves:
in severe Celluli5s
(Nectro5zing fascii5s)

Staph

Strep

Purulent

Nonpurulent

Gram +

Celluli5s

1. Purulent always I&D

mild: only I&D
moderate: + Bactrim/Doxy/Clindamycin
severe: + Vancomycin/Linezolid

Gram -

2. Nonpurlent no I&D
mild: PO Abx Peniclllin/Keex/Clidamycin
Moderate: IV Abx Penicillin/Cefazolin/Clindamycin
Severe: Vanc+ Zosyn + imaging/surgery to
The Yale 20
r/o and treat necro5zing fascii5s