A middle aged man with stage IV HCC of unknown etiology who presented 2 weeks after biliary stent placement with confusion found to have E. Coli bacteremia.
**Learning point for Gram-negative bacteremia
-Treat presumptively with Zosyn – consider 2nd gram negative agent if: immunocompromised; high risk for P. aeruginosa, or unit antibiogram shows drug resistance > 20-25% for GNR pathogens
Risk factors for P. aeruginosa
-Current hospitalization or admission to an intensive care unit
-Recent P. aeruginosa infection
-Admission from along-term care facility
-Recent IV abx