Gram Stain

GRAM NEGATIVE
Rods

GRAM POSITIVE
Cocci

Clusters

SPACE

Chains or Pairs

Enteric-Like

STAPHYLOCOCCUS:

Positive

Type of Hemolysis?

Negative

alpha

S-erratia
P-seudomonas
A-cinetobacter
C-itrobacter
E-nterobacter

gamma
beta

Staphylococcus
aureus

Coagulase-Negative
Staph
( hemolyticus,
epidermidis, etc)

Treatment
MSSA:
Cefazolin
OR
Oxacillin

Determine if:
Infection
OR
Contaminant

If MRSA:

Skin

If true infection:

Blood

viridans
pneumoniae

Group A (pyogenes)
Group B (agalactiae)
Group C
Group G

Penicillin
OR
Other beta-lactam
with narrow
spectrum

Vancomycin
(if MIC <1 .5)
OR
Daptomycin*
(if MIC <1 )

MSSEbeta -lactam
(cefazolin or
oxacillin)

If allergy:
Levofloxacin
Clindamycin
Vancomycin
If resistant:
Call ID

Jackson Memorial Hospital Antimicrobial Stewardship Program

Lilian Abbo, MD, Laura Smith, PharmD
2010

Treatment

Treatment

Treatment

E. coli
Klebsiella
Proteus

Consider risk
if in ICU

Enterococcus

Treatment

MRSE- Vancomycin
- Trim/Sulfa
-Minocycline
-Doxycycline
-Vancomycin
-Linezolid*
-Daptomycin*
-Tigecycline*

Multi-Drug
Resistant
Acinetobacter

STREPTOCOCCUS:

Coagulase
Positive or Negative?

Usually susceptible to
multiple antibiotics

May require
colistin IV

Choose antimicrobial
with narrowest
spectrum

Cefepime
If mixed infection:
May use piperacillin/
tazo

Drug of choice:
Ampicillin
If resistant or allergy:
Vancomycin
If resistant to amp and
vanc:
VRE- use linezolid* or
daptomycin*

If ESBL positive

If resistant:
May need
carbapenem*

Urine

Blood
Carbapenem*

* Require approval from

ASP or ID

Wound

Carbapenem*
OR
Tigecycline*

Low dose
aminoglycoside
OR
Carbapenem*