Gram Negative Bacteremia

a) First piece of information which comes back on cultures is lactose fermentation status, which is helpful in guiding therapy

• SPICE-A organisms are lactose negative (Serratia, Pseudomonas, Indole-negative proteus, Citrobacter, Enterobacter, Acinetobacter)
• Thus, if species is lactose fermenting, can effectively rule out Pseudomonas

b) GNR bacteremia can be treated with fluoroquinolones, given excellent oral bioavailabilty

(Christopher Woo MD, 12/14/10)