First-line antibiotics in sepsis of unknown origin

What are the first-line antibiotics in sepsis of unknown origin?

Emilie Belley-Côté, MD: I tend to go with a broad-spectrum antibiotic that has gram-positive and gram-negative coverage, such as Tazocin—piperacillin/tazobactam. If the patients are quite sick, I will add vancomycin.

That being said, if the patient has been in hospital for more than 48 hours, has been exposed to broad-spectrum antibiotics in the past, or is known to have had in the past an infection with an extended-spectrum beta-lactamase (ESBL)–producing bacteria, then I will go with a carbapenem as first-line coverage instead.