| ConditionalID | Rec | CUI Codes | CPT Codes |
|---|---|---|---|
| 32470 | A thorough history and physical examination should be obtained/ performed in patients presenting with HF to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of HF. (I-C) | C0012634,C0018799,C0031809,C0262926 | 1014526 |
| 32471 | In patients with idiopathic dilated cardiomyopathy (DCM), a 3-generational family history should be obtained to aid in establishing the diagnosis of familial DCM. | C0011900,C0033141,C0241889,C0262926,C0878544 | 1014981 |
| 32472 | Volume status and vital signs should be assessed at each patient encounter. This includes serial assessment of weight, as well as estimates of jugular venous pressure and the presence of peripheral edema or orthopnea. | C0013604,C0085619,C0085649,C0311392,C0392148,C0428897,C0460139,C1261322 | |
| 32474 | Initial laboratory evaluation of patients presenting with HF should include a complete blood cell count, urinalysis, measurement of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, and thyroid-stimulating hormone, a fasting lipid profile, and liver function tests. | C0005767,C0005771,C0005773,C0005845,C0006675,C0007584,C0007634,C0009555,C0010294,C0013832,C0015663,C0017725,C0019932,C0023779,C0023884,C0023901,C0024467,C0028158,C0040132,C0040135,C0040160,C0041942,C0042014,C0201976,C0229671,C0430044,C0587355,C0600137,C1261322,C1269647,C1278929,C1291218 | 1011223,1011229,1011761,80047,80048,80069,81005,81099,84520 |
| 32475 | Serial monitoring, when indicated, should include serum electrolyte levels and renal function. | C0013832,C0181904,C0229671,C1287347,C2946261 | |
| 32476 | A 12-lead electrocardiogram should be performed initially on all patients presenting with HF | C0013798,C0023175,C1623258 | |
| 32477 | Screening for hemochromatosis or HIV is reasonable in selected patients who present with HF. | C0018995,C0220908 | |
| 32478 | Diagnostic tests for rheumatological diseases, amyloidosis, or pheochromocytoma are reasonable in patients presenting with HF in whom there is a clinical suspicion of these diseases. | C0002726,C0012634,C0031511 | |
| 32479 | For patients at risk of developing HF, natriuretic peptide biomarker–based screening followed by team-based care, including a cardiovascular specialist optimizing GDMT, can be useful to prevent the development of left ventricular dysfunction (systolic or diastolic) or new-onset HF. | C0030956,C0220908,C1273070,C1277187 | |
| 32480 | In patients presenting with dyspnea, measurement of natriuretic peptide biomarkers is useful to support a diagnosis or exclusion of HF. | C0011900,C0013404,C0030956 | |
| 32481 | Measurement of BNP or NT-proBNP is useful for establishing prognosis or disease severity in chronic HF. | C0012634,C0033325 | |
| 32482 | Measurement of baseline levels of natriuretic peptide biomarkers and/or cardiac troponin on admission to the hospital is useful to establish a prognosis in acutely decompensated HF. | C0030956,C0033325,C0041199,C0184666,C2946261 | |
| 32483 | During a HF hospitalization, a predischarge natriuretic peptide level can be useful to establish a postdischarge prognosis. | C0030956,C0033325,C2946261 | |
| 32484 | In patients with chronic HF, measurement of other clinically available tests, such as biomarkers of myocardial injury or fibrosis, may be considered for additive risk stratification. | C0016059,C0449210,C3263722,C3263723 | |
| 32485 | Patients with suspected or new-onset HF, or those presenting with acute decompensated HF, should undergo a chest x-ray to assess heart size and pulmonary congestion and to detect alternative cardiac, pulmonary, and other diseases that may cause or contribute to the patient’s symptoms. | C0012634,C0018787,C0018799,C0039985,C0242073,C0449210,C0700148,C0817096,C1281570,C1306645,C1457887,C1962945 | 1010354,1031050 |
| 32486 | A 2-dimensional echocardiogram with Doppler should be performed during initial evaluation of patients presenting with HF to assess ventricular function, size, wall thickness, wall motion, and valve function. | C0013516,C0554756,C1261322 | 1013050 |
| 32487 | Repeat measurement of EF and measurement of the severity of structural remodeling are useful to provide information in patients with HF who have had a significant change in clinical status; who have experienced or recovered from a clinical event; or who have received treatment, including GDMT, that might have had a significant effect on cardiac function; or who may be candidates for device therapy. | C0087111 | 97139 |
| 32488 | Noninvasive imaging to detect myocardial ischemia and viability is reasonable in patients presenting with de novo HF, who have known CAD and no angina, unless the patient is not eligible for revascularization of any kind. | C0002962,C0011923,C0022116,C0151744,C0581603 | |
| 32489 | Viability assessment is reasonable in select situations when planning revascularization in HF patients with CAD. | C0581603,C1261322 | |
| 32490 | Radionuclide ventriculography or magnetic resonance imaging can be useful to assess LVEF and volume when echocardiography is inadequate. | C0011923,C0013516,C0024485,C0034610,C0231881 | 1013050,76498 |
| 32491 | Magnetic resonance imaging is reasonable when assessing myocardial infiltrative processes or scar burden. | C0011923,C0024485,C0231881,C2004491 | 76498 |
| 32492 | Routine repeat measurement of LV function assessment in the absence of clinical status change or treatment interventions should NOT be performed. | C1261322,C1273869,C1689985 | |
| 32493 | Invasive hemodynamic monitoring with a pulmonary artery catheter should be performed to guide therapy in patients who have respiratory distress or clinical evidence of impaired perfusion in whom the adequacy or excess of intracardiac filling pressures cannot be determined from clinical assessment. | C0003842,C0031001,C0034052,C0085590,C0087111,C0150264,C0161959,C0179790,C0181904,C0302614,C0460139,C0476273,C0729936,C1261322,C1269026 | 97139 |
| 32494 | Invasive hemodynamic monitoring can be useful for carefully selected patients with acute HF who have persistent symptoms despite empiric adjustment of standard therapies, and: • Whose fluid status, perfusion, or systemic or pulmonary vascular resistance is uncertain; • Whose systolic pressure remains low, or is associated with symptoms, despite initial therapy; • Whose renal function is worsening with therapy; • Who require parenteral vasoactive agents; or • Who may need consideration for mechanical circulatory support (MCS) or transplantation. | C0031001,C0040732,C0087111,C0150264,C0161959,C0181904,C0183683,C0344211,C0450442,C0460139,C1457887 | 97139 |
| 32495 | When ischemia may be contributing to HF, coronary arteriography is reasonable for patients eligible for revascularization. (IIa-C) | C0003844,C0022116,C0085532,C0581603 | |
| 32496 | Endomyocardial biopsy can be useful in patients presenting with HF when a specific diagnosis is suspected that would influence therapy. | C0005558,C0011900,C0087111,C0189785 | 93505,97139 |
| 32497 | Routine use of invasive hemodynamic monitoring is NOT recommended in normotensive patients with acute decompensated HF and congestion with symptomatic response to diuretics and vasodilators. | C0012798,C0042402,C0150264,C0161959,C0181904,C0522563,C0700148,C2712122 | |
| 32498 | Endomyocardial biopsy should NOT be performed in the routine evaluation of patients with HF. | C0005558,C0189785,C1261322 | 93505 |
| 32500 | Other conditions that may lead to or contribute to HF, such as obesity, diabetes mellitus, tobacco use, and known cardiotoxic agents, should be controlled or avoided. | C0011849,C0028754,C0040329,C0449210,C0450442 | |
| 32501 | In all patients with a recent or remote history of MI or acute coronary syndrome and reduced EF, angiotensin-converting enzyme (ACE) inhibitors should be used to prevent symptomatic HF and reduce mortality. In patients intolerant of ACE inhibitors, angiotensin-receptor blockers are appropriate unless contraindicated. | C0003015,C0003018,C0014442,C0022709,C0034787,C0039082,C0262926,C0597357,C0948089 | |
| 32503 | In all patients with a recent or remote history of MI or acute coronary syndrome and reduced EF, evidence-based beta blockers should be used to reduce mortality. | C0039082,C0262926,C0948089 | |
| 32504 | In all patients with a recent or remote history of MI or acute coronary syndrome, statins should be used to prevent symptomatic HF and cardiovascular events. | C0039082,C0262926,C0360714,C0948089,C1320716 | |
| 32505 | In patients with structural cardiac abnormalities, including LV hypertrophy, in the absence of a history of MI or ACS, blood pressure should be controlled in accordance with clinical practice guidelines for hypertension to prevent symptomatic HF. | C0005767,C0020538,C0020564,C0149721,C0262926,C0460139,C1272641,C1689985 | |
| 32506 | ACE inhibitors should be used in all patients with a reduced EF to prevent symptomatic HF, even if they do not have a history of MI. | C0003015,C0262926 | |
| 32507 | Beta blockers should be used in all patients with a reduced EF to prevent symptomatic HF, even if they do not have a history of MI. | C0262926 | |
| 32508 | To prevent sudden death, placement of an implantable cardioverterdefibrillator (ICD) is reasonable in patients with asymptomatic ischemic cardiomyopathy who are ?40 days post-MI, have an LVEF of ?30%, are on appropriate medical therapy, and have a reasonable expectation of survival with a good functional status for >1 year. | C0011071,C0087111,C0231221,C0349782,C0418981,C0441587,C0878544,C1306577,C1533810 | 97139 |
| 32509 | Nondihydropyridine calcium channel blockers with negative inotropic effects may be harmful in asymptomatic patients with low LVEF and no symptoms of HF after MI. | C0006675,C0006684,C0231221,C1457887 | |
| 32510 | Patients with HF should receive specific education to facilitate HF self-care. | C0013658,C0039401,C0424927 | |
| 32511 | Sodium restriction is reasonable for patients with symptomatic HF to reduce congestive symptoms. | C0037473,C1457887 | |
| 32512 | Exercise training (or regular physical activity) is recommended as safe and effective for patients with HF who are able to participate to improve functional status. (I-A) | C0220931 | |
| 32513 | Cardiac rehabilitation can be useful in clinically stable patients with HF to improve functional capacity, exercise duration, health-related quality of life (HRQOL), and mortality. | C0034991,C0518214,C0700431,C1998319,C2926735 | |
| 32516 | HFrEF NYHA class I–IV (Stage C) ACEI or ARB AND GDMT beta blocker; diuretics as needed (COR I) | C0012798,C0028778 | |
| 32517 | NYHA class II–IV, provided est. CrCl >30 mL/min & K+ <5.0 mEq/L implement Aldosterone antagonist (COR I) | C0002006,C0002007 | |
| 32520 | NYHA class II–III, LVEF ?35%; (caveat: >1 y survival, >40 d post MI) implement implantable cardioverter-defibrillator | C0162589,C0180307 | |
| 32522 | NYHA class II–III, NSR, heart rate ?70 bpm on maximally tolerated dose beta blocker | C0018787,C0028778,C1281570 | |
| 32523 | patients are Stage D refractory NYHA class III-IV consider additional therapy of palliative care (COR I) or transplant (COR I) or left ventricular assist device (COR IIa) or Investigational studies | C0030231,C0040732,C0085842,C0087111,C0181598,C0332835 | 97139 |
| 32524 | Diuretics are recommended in patients with HFrEF with fluid retention | C0012798,C0268000 | |
| 32525 | ACE inhibitors are recommended for all patients with HFrEF | C0003015 | |
| 32526 | ARBs are recommended in patients with HFrEF who are ACE inhibitor–intolerant | C0003015 | |
| 32529 | Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful for patients with HFrEF. | C0002006,C0002007,C0003015 | |
| 32531 | Aldosterone receptor antagonists are recommended in patients with NYHA class II–IV HF who have LVEF ?35% | C0002006,C0002007,C0597357 | |
| 32532 | Aldosterone receptor antagonists are recommended to reduce morbidity and mortality following an acute MI in patients who have LVEF of ?40% who develop symptoms of HF or who have a history of diabetes mellitus, unless contraindicated. | C0002006,C0002007,C0011849,C0262926,C0597357,C1457887 | |
| 32533 | Inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is >2.5 mg/dL in men or >2.0 mg/dL in women (or estimated glomerular filtration rate <30 mL/min/1.73 m2), and/or potassium >5.0 mEq/L. | C0002006,C0002007,C0010294,C0017654,C0020461,C0032821,C0035078,C0201976,C0229671,C0597357 | |
| 32534 | The combination of hydralazine and isosorbide dinitrate is recommended for African Americans with NYHA class III–IV HFrEF on GDMT | C0020223,C0022251,C0022252 | |
| 32535 | A combination of hydralazine and isosorbide dinitrate can be useful in patients with HFrEF who cannot be given ACE inhibitors or ARBs | C0003015,C0020223,C0022251,C0022252 | |
| 32536 | Digoxin can be beneficial in patients with HFrEF, unless contraindicated, to decrease hospitalizations for HF. | C0012265 | |
| 32537 | Patients with chronic HF with permanent/persistent/paroxysmal AF and an additional risk factor for cardioembolic stroke (history of hypertension, diabetes mellitus, previous stroke or transient ischemic attack, or ?75 years of age) should receive chronic anticoagulant therapy (in the absence of contraindications to anticoagulation). | C0003280,C0007787,C0011849,C0020538,C0038454,C0087111,C0150457,C0262926,C1304680,C1531624 | 97139 |
| 32538 | The selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal AF should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( | C0003280,C0013227,C0043031,C0449210,C0450442,C0525032,C1739768,C1831808,C1874451 | |
| 32539 | Chronic anticoagulation is reasonable for patients with chronic HF who have permanent/persistent/paroxysmal AF but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). ( | C0038454,C1531624 | |
| 32540 | Anticoagulation is NOT recommended in patients with chronic HFrEF without AF, a prior thromboembolic event, or a cardioembolic source | C0449416 | |
| 32541 | Statins are NOT beneficial as adjunctive therapy when prescribed solely for HF | C0087111,C0360714 | 97139 |
| 32543 | Nutritional supplements as treatment for HF are NOT recommended in patients with current or prior symptoms of HFrEF. ( | C1457887 | |
| 32545 | Drugs known to adversely affect the clinical status of patients with current or prior symptoms of HFrEF are potentially harmful and should be avoided or withdrawn whenever possible (eg, most antiarrhythmic drugs, most calcium channel–blocking drugs [except amlodipine], nonsteroidal anti-inflammatory drugs, or thiazolidinediones). | C0003195,C0006675,C0013227,C0051696,C1257987,C1457887 | |
| 32546 | Long-term use of infused positive inotropic drugs is potentially harmful for patients with HFrEF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment | C0012634,C0013227,C0354668 | |
| 32548 | The clinical strategy of inhibition of the renin-angiotensin system with ACE inhibitors OR ARBs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic HFrEF to reduce morbidity and mortality. | C0002006,C0002007,C0003015,C0003018,C0035094,C1960108 | |
| 32549 | The clinical strategy of inhibition of the renin-angiotensin system with ARNI in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic HFrEF to reduce morbidity and mortality. | C0002006,C0002007,C0003018,C0035094 | |
| 32550 | The use of ACE inhibitors is beneficial for patients with prior or current symptoms of chronic HFrEF to reduce morbidity and mortality. | C0003015,C1457887 | |
| 32551 | The use of ARBs to reduce morbidity and mortality is recommended in patients with prior or current symptoms of chronic HFrEF who are intolerant to ACE inhibitors because of cough or angioedema. | C0002994,C0003015,C0010200,C1457887 | |
| 32552 | In patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACE inhibitor or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality. | C0003015,C0035139 | |
| 32553 | Angiotensin receptor-neprilysin inhibitor should not be administered concomitantly with ACE inhibitors or within 36 hours of the last dose of an ACE inhibitor. | C0003015,C0003018,C0034787,C0597357 | |
| 32554 | Angiotensin receptor-neprilysin inhibitor should not be administered to patients with a history of angioedema. | C0002994,C0003018,C0034787,C0262926,C0597357 | |
| 32555 | Ivabradine can be beneficial to reduce HF hospitalization for patients with symptomatic (NYHA class II-III) stable chronic HFrEF (LVEF ?35%) who are receiving GDEM, including a beta blocker at maximum tolerated dose, and who are in sinus rhythm with a heart rate of ?70 bpm at rest. | C0016169,C0018787,C0028778,C0232201,C0257190,C0423772,C1281570 | |
| 32556 | Diuretics are recommended in patients with HFrEF who have evidence of fluid retention, unless contraindicated, to improve symptoms. | C0012798,C0268000,C1457887 | |
| 32557 | ACE inhibitors are recommended in patients with HFrEF and current or prior symptoms, unless contraindicated, to reduce morbidity and mortality. (I-A) | C0003015,C1457887 | |
| 32558 | ARBs are recommended in patients with HFrEF with current or prior symptoms who are ACE inhibitor–intolerant, unless contraindicated, to reduce morbidity and mortality. | C0003015,C1457887 | |
| 32559 | ARBs are reasonable to reduce morbidity and mortality as alternatives to ACE inhibitors as first-line therapy for patients with HFrEF, especially for patients already taking ARBs for other indications, unless contraindicated. | C0003015,C0087111,C0449210 | 97139 |
| 32560 | Addition of an ARB may be considered in persistently symptomatic patients with HFrEF who are already being treated with an ACE inhibitor and a beta blocker in whom an aldosterone antagonist is not indicated or tolerated. | C0002006,C0002007,C0003015,C0028778 | |
| 32562 | Use of 1 of the 3 beta blockers proven to reduce mortality (ie, bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of HFrEF, unless contraindicated, to reduce morbidity and mortality. | C0025859,C0053799,C0054836,C0220918,C0724633,C1457887,C1963578,C2732140 | |
| 32563 | Aldosterone receptor antagonists (or mineralocorticoid receptor antagonists) are recommended in patients with NYHA class II–IV and who have LVEF of ?35%, unless contraindicated, to reduce morbidity and mortality. Patients with NYHA class II should have a history of prior cardiovascular hospitalization or elevated plasma natriuretic peptide levels to be considered for aldosterone receptor antagonists. Creatinine levels should be ?2.5 mg/dL in men or ?2.0 mg/dL in women (or estimated glomerular filtration rate >30 mL/min/1.73 m2) 2) and potassium levels should be <5.0 mEq/L. Careful monitoring of potassium levels, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insufficiency. | C0002006,C0002007,C0010294,C0012798,C0017654,C0020461,C0030956,C0032105,C0032821,C0035078,C0181904,C0262926,C0597357,C2946261 | |
| 32566 | The combination of hydralazine and isosorbide dinitrate is recommended to reduce morbidity and mortality for patients selfdescribed as African Americans with NYHA class III–IV HFrEF receiving optimal therapy with ACE inhibitors and beta blockers, unless contraindicated. | C0003015,C0020223,C0022251,C0022252,C0087111 | 97139 |
| 32567 | A combination of hydralazine and isosorbide dinitrate can be useful to reduce morbidity or mortality in patients with current or prior symptomatic HFrEF who cannot be given an ACE inhibitor or ARB because of drug intolerance, hypotension, or renal insufficiency, unless contraindicated. | C0003015,C0013227,C0020223,C0020649,C0022251,C0022252,C0035078,C0277585 | |
| 32570 | The selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal AF should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. | C0003280,C0013227,C0043031,C0449210,C0450442,C0525032,C1739768,C1831808,C1874451 | |
| 32571 | Chronic anticoagulation is reasonable for patients with chronic HF who have permanent/persistent/paroxysmal AF but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). | C0038454,C1531624 | |
| 32572 | Anticoagulation is NOT recommended in patients with chronic HFrEF without AF, a prior thromboembolic event, or a cardioembolic source. (III-B: No Benefit) | C0449416 | |
| 32573 | Statins are NOT beneficial as adjunctive therapy when prescribed solely for the diagnosis of HF in the absence of other indications for their use. | C0011900,C0087111,C0360714,C0449210,C1689985 | 97139 |
| 32574 | Omega-3 polyunsaturated fatty acid (PUFA) supplementation is reasonable to use as adjunctive therapy in patients with NYHA class II–IV symptoms and HFrEF or HFpEF, unless contraindicated, to reduce mortality and cardiovascular hospitalizations. | C0001128,C0015684,C0015689,C0032615,C0087111,C1457887 | 97139 |
| 32575 | Nutritional supplements as treatment for HF are NOT recommended in patients with current or prior symptoms of HFrEF. | C1457887 | |
| 32576 | Hormonal therapies other than to correct deficiencies are NOT recommended for patients with current or prior symptoms of HFrEF. | C1457887 | |
| 32578 | Long-term use of infused positive inotropic drugs is potentially harmful for patients with HFrEF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage D starting on page 34). | C0012634,C0013227,C0354668 | |
| 32579 | Calcium channel–blocking drugs are NOT recommended as routine treatment for patients with HFrEF. | C0006675,C0013227 | |
| 32580 | Systolic and diastolic blood pressure should be controlled in patients with HFpEF in accordance with published clinical practice guidelines to prevent morbidity. | C0005767,C0460139,C1272641 | |
| 32581 | Diuretics should be used for relief of symptoms due to volume overload in patients with HFpEF. | C0012798,C0564405,C1457887 | |
| 32582 | Coronary revascularization is reasonable in patient with CAD in whom symptoms (angina) or demonstrable myocardial ischemia is judged to be having an adverse effect on symptomatic HFpEF despite GDMT. | C0002962,C0022116,C0151744,C0581603,C1457887 | |
| 32584 | The use of beta-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control blood pressure in patients with HFpEF. | C0003015,C0005767,C0020538,C0450442,C0460139,C1272641 | |
| 32585 | In appropriately selected patients with HFpEF (with EF ?45%, elevated BNP levels or HF admission within 1 year, estimated glomerular filtration rate >30 mL/min, creatinine <2.5 mg/dL, potassium <5.0 mEq/L), aldosterone receptor antagonists might be considered to decrease hospitalizations. | C0002006,C0002007,C0010294,C0017654,C0032821,C0597357,C2946261 | |
| 32587 | Routine use of nitrates or phosphodiesterase-5 inhibitors to increase activity or QoL in patients with HFpEF is ineffective. | C0028125 | |
| 32589 | ICD therapy is recommended for primary prevention of sudden cardiac death (SCD) to reduce total mortality in selected patients with nonischemic DCM or ischemic heart disease ?40 days post-MI with LVEF of ?35% and NYHA class II or III symptoms on chronic GDMT, who have a reasonable expectation of meaningful survival for >1 year.a .a (I-A) | C0011071,C0012634,C0018787,C0018799,C0033144,C0085298,C0087111,C0151744,C0199176,C0439631,C1281570,C1306577,C1457887 | 97139 |
| 32590 | Cardiac resynchronization therapy is indicated for patients who have LVEF of 35% or less, sinus rhythm, left bundle-branch block (LBBB) with a QRS duration of 150 ms or greater, and NYHA class II, III, or ambulatory class IV symptoms on GDMT. | C0006384,C0016169,C0023211,C0028778,C0087111,C0225917,C0232201,C0423772,C1457887,C2926735 | 97139 |
| 32591 | ICD therapy is recommended for primary prevention of SCD to reduce total mortality in selected patients at least 40 days post-MI with LVEF of 30% or less and NYHA class I symptoms while receiving GDMT, who have a reasonable expectation of meaningful survival for more than 1 year. | C0033144,C0087111,C0199176,C0439631,C1457887 | 97139 |
| 32592 | CRT can be useful for patients who have LVEF of ?35% , sinus rhythm, a non-LBBB pattern with a QRS duration of ?150 ms, and NYHA class III/ambulatory class IV symptoms on GDMT. | C0016169,C0232201,C0423772,C1457887,C2926735 | |
| 32593 | CRT can be useful for patients who have LVEF of ?35%, sinus rhythm, LBBB with a QRS duration of 120–149 ms, and NYHA class II, III, or ambulatory class IV symptoms on GDMT. | C0016169,C0232201,C0423772,C1457887,C2926735 | |
| 32594 | CRT can be useful in patients with AF and LVEF of ?35% on GDMT if a) the patient requires ventricular pacing or otherwise meets CRT criteria and b) atrioventricular nodal ablation or pharmacological rate control will allow near 100% ventricular pacing with CRT. | C0308718,C0547070 | |
| 32595 | CRT can be useful for patients on GDMT who have LVEF of ?35% and are undergoing placement of a new or replacement device with anticipated requirement for significant (>40%) ventricular pacing. | C0021107,C0035139,C0441587,C1533810 | |
| 32596 | The usefulness of implantation of an ICD is of uncertain benefit to prolong meaningful survival in patients with a high risk of nonsudden death as predicted by frequent hospitalizations, advanced frailty, or comorbidities such as systemic malignancy or severe renal dysfunction. | C0021107,C0424594,C1306459,C1306577 | |
| 32597 | CRT may be considered for patients who have LVEF of ?35%, sinus rhythm, a non-LBBB pattern with a QRS duration of 120–149 ms, and NYHA class III/ambulatory class IV on GDMT. | C0016169,C0232201,C0423772,C2926735 | |
| 32598 | CRT may be considered for patients who have LVEF of ?35%, sinus rhythm, a non-LBBB pattern with a QRS duration of ?150 ms, and NYHA class II symptoms on GDMT. | C0016169,C0232201,C0423772,C1457887,C2926735 | |
| 32599 | CRT may be considered for patients who have LVEF of ?30%, ischemic etiology of HF, sinus rhythm, LBBB with a QRS duration of ?150 ms, and NYHA class I symptoms on GDMT. | C0016169,C0232201,C0423772,C1457887,C2926735 | |
| 32600 | CRT is NOT recommended for patients with NYHA class I or II symptoms and non-LBBB pattern with a QRS duration of <150 ms. | C1457887,C2926735 | |
| 32601 | CRT is NOT indicated for patients whose comorbidities and/or frailty limit survival with good functional capacity to <1 year. | C0424594,C1998319 | |
| 32602 | Fluid restriction (1.5–2 L/d) is reasonable in stage D, especially in patients with hyponatremia, to reduce congestive symptoms. | C0020625,C0204700,C1457887 | |
| 32603 | Until definitive therapy (eg, coronary revascularization, MCS, heart transplantation) or resolution of the acute precipitating problem, patients with cardiogenic shock should receive temporary intravenous inotropic support to maintain systemic perfusion and preserve endorgan performance. | C0018787,C0018823,C0031001,C0033213,C0036974,C0036980,C0040732,C0087111,C0183683,C0344211,C0581603,C1281570 | 33945,97139 |
| 32604 | Continuous intravenous inotropic support is reasonable as “bridge therapy” in patients with stage D HF refractory to GDMT and device therapy who are eligible for and awaiting MCS or cardiac transplantation. | C0040732,C0087111,C0183683,C0344211,C0456378 | 97139 |
| 32605 | Short-term, continuous intravenous inotropic support may be reasonable in those hospitalized patients presenting with documented severe systolic dysfunction who present with low blood pressure and significantly depressed cardiac output to maintain systemic perfusion and preserve end-organ performance. | C0005767,C0020649,C0031001,C0183683,C0344211,C0344315,C0460139,C0749225,C1272641 | |
| 32606 | Long-term, continuous intravenous inotropic support may be considered as palliative therapy for symptom control in select patients with stage D HF despite optimal GDMT and device therapy who are not eligible for either MCS or cardiac transplantation. | C0040732,C0087111,C0183683,C0308718,C0344211,C1274136,C1457887 | 97139 |
| 32607 | Long-term use of either continuous or intermittent, intravenous parenteral positive inotropic agents, in the absence of specific indications or for reasons other than palliative care, is potentially harmful in the patient with HF. | C0030231,C0304509,C0450442,C1689985 | |
| 32608 | Use of parenteral inotropic agents in hospitalized patients without documented severe systolic dysfunction, low blood pressure, or impaired perfusion, and evidence of significantly depressed cardiac output, with or without congestion, is potentially harmful. | C0005767,C0020649,C0031001,C0304509,C0344315,C0450442,C0460139,C0700148,C0749225,C1272641 | |
| 32609 | MCS is beneficial in carefully selected patients with stage D HFrEF in whom definitive management (eg, cardiac transplantation) or cardiac recovery is anticipated or planned. | C0040732 | |
| 32610 | Nondurable MCS, including the use of percutaneous and extracorporeal ventricular assist devices, is reasonable as a “bridge to recovery” or a “bridge to decision” for carefully selecteda HFrEF a H patients with acute, profound hemodynamic compromise. | C0456378 | |
| 32612 | Evaluation for cardiac transplantation is indicated for carefully selected patients with stage D HF despite GDMT, device, and surgical management. | C0040732,C0543467,C1261322 | 1003143 |
| 32613 | ACS precipitating acute HF decompensation should be promptly identified by ECG and serum biomarkers, including cardiac troponin testing, and treated optimally as appropriate to the overall condition and prognosis of the patient. | C0033325,C0041199,C0229671,C0231187,C1623258 | |
| 32614 | Common precipitating factors for acute HF should be considered during initial evaluation, as recognition of these conditions is critical to guide appropriate therapy. | C0087111,C1261322 | 97139 |
| 32615 | In patients with HFrEF experiencing a symptomatic exacerbation of HF requiring hospitalization during chronic maintenance treatment with GDMT, it is recommended that GDMT be continued in the absence of hemodynamic instability or contraindications. | C0948268,C1444783 | |
| 32616 | Initiation of beta-blocker therapy is recommended after optimization of volume status and successful discontinuation of intravenous diuretics, vasodilators, and inotropic agents. Beta-blocker therapy should be initiated at a low dose and only in stable patients. | C0012798,C0028778,C0042402,C0087111,C0304509,C0450442,C0457454 | 97139 |
| 32618 | Patients with HF admitted with evidence of significant fluid overload should be promptly treated with intravenous loop diuretics to reduce morbidity. | C0012798,C0354100,C0546817 | |
| 32619 | If patients are already receiving loop diuretic therapy, the initial intravenous dose should equal or exceed their chronic oral daily dose | C0012798,C0087111,C0354100 | 97139 |
| 32620 | The effect of HF treatment should be monitored with careful measurement of fluid intake and output, vital signs, body weight that is determined at the same time each day, and clinical signs and symptoms of systemic perfusion and congestion. Daily serum electrolytes, urea nitrogen, and creatinine concentrations should be measured during the use of intravenous diuretics or active titration of HF medications. | C0010294,C0012798,C0013227,C0013832,C0028158,C0031001,C0041942,C0229671,C0311392,C0587355,C0700148,C1291218,C1457887 | |
| 32621 | When diuresis is inadequate to relieve symptoms, it is reasonable to intensify the diuretic regimen using either: a. Higher doses of intravenous loop diuretics (IIa-B), or b. Addition of a second (eg, thiazide) diuretic (IIa-B). | C0012798,C0354100,C1457887 | |
| 32622 | Low-dose dopamine infusion may be considered in addition to loop diuretic therapy to improve diuresis and better preserve renal functio and renal blood flow. | C0005767,C0012798,C0013030,C0087111,C0354100,C0574032 | 97139 |
| 32623 | Ultrafiltration may be considered for patients with obvious volume overload to alleviate congestive symptoms and fluid weight. | C0041612,C1274136,C1457887 | |
| 32624 | Ultrafiltration may be considered for patients with refractory congestion not responding to medical therapy. | C0041612,C0087111,C0418981,C0700148 | 97139 |
| 32625 | If symptomatic hypotension is absent, intravenous nitroglycerin, nitroprusside, or nesiritide may be considered as an adjuvant to diuretic therapy for relief of dyspnea in patients admitted with acute decompensated HF. | C0001551,C0012798,C0013404,C0017887,C0020649,C0028193,C0054015,C0087111,C0564405 | 97139 |
| 32626 | A patient admitted to the hospital with decompensated HF should receive venous thromboembolism prophylaxis with an anticoagulant medication if the risk–benefit ratio is favorable. | C0003280,C0013227,C0040038,C0199176 | |
| 32627 | In patients hospitalized with volume overload, including HF, who have persistent severe hyponatremia and are at risk for or having active cognitive symptoms despite water restriction and maximization of GDMT, vasopressin antagonists may be considered in the short term to improve serum sodium concentration in hypervolemic, hyponatremic states with either a V2 receptor–selective or a nonselective vasopressin antagonist. | C0020625,C0037473,C0043047,C0229671,C0457423,C0523891,C0597357,C1457887,C1705480 | 84295 |
| 32629 | Throughout the hospitalization as appropriate, before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed (I-B): a. Initiation of GDMT if not previously established and not contraindicated b. Precipitant causes of HF, barriers to optimal care transitions, and limitations in postdischarge support c. Assessment of volume status and supine/upright hypotension with adjustment of HF therapy, as appropriate d. Titration and optimization of chronic oral HF therapy e. Assessment of renal function and electrolytes, where appropriate f. Assessment and management of comorbid conditions g. Reinforcement of HF education, self-care, emergency plans, and need for adherence h. Consideration for palliative care or hospice care in selected patients | C0012621,C0013658,C0013832,C0020649,C0030231,C0039401,C0085555,C0087111,C0183683,C0344211,C0424927,C0587355,C0589120,C0600083,C0678211,C1261322,C1275743 | 97139 |
| 32630 | Multidisciplinary HF disease-management programs are recommended for patients at high risk for hospital readmission, to facilitate the implementation of GDMT, to address different barriers to behavioral change, and to reduce the risk of subsequent rehospitalization for HF. | C0012634,C1303150,C2728259 | |
| 32631 | Scheduling an early follow-up visit (within 7–14 days) and early telephone follow-up (within 3 days) of hospital discharge is reasonable. | C0012621,C0589120,C0600083 | |
| 32633 | In patients with NYHA class II and III HF and iron deficiency (ferritin <100 ng/mL or 100–300 ng/mL if transferrin saturation is <20%), intravenous iron replacement might be reasonable to improve functional status and QoL. | C0015879,C0035139,C0040679,C0162429,C0240066,C0302583,C0332155,C0392916,C1277709 | |
| 32634 | In patients with HF and anemia, erythropoietin-stimulating agents should not be used to improve morbidity and mortality. | C0002871,C0014822,C0450442 | |
| 32635 | In patients at increased risk, stage A HF, the optimal blood pressure in those with hypertension should be <130/80 mm Hg. | C0005767,C0020538,C0460139,C1272641 | |
| 32636 | Patients with HFrEF and hypertension should be prescribed GDMT titrated to attain systolic blood pressure <130 mm Hg. | C0005767,C0020538,C0460139,C1272641 | |
| 32637 | Patients with HFpEF and persistent hypertension after management of volume overload should be prescribed GDMT titrated to attain systolic blood pressure <130 mm Hg | C0005767,C0020538,C0460139,C1272641 | |
| 32638 | In patients with NYHA class II–IV HF and suspicion of sleep disordered breathing or excessive daytime sleepiness, a formal sleep assessment is reasonable | C0013144,C0225386,C0917799,C1261322 | |
| 32639 | In patients with cardiovascular disease and obstructive sleep apnea, CPAP may be reasonable to improve sleep quality and daytime sleepiness | C0003578,C0007222,C0012634,C0013144,C0037315,C0520679 | |
| 32640 | In patients with NYHA class II–IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm | C0003578,C0037315,C0520680 | |
| 32641 | Coronary artery revascularization via coronary artery bypass graft (CABG) or percutaneous intervention is indicated for patients (HFpEF and HFrEF) on GDMT with angina and suitable coronary anatomy, especially for a left main stenosis (>50%) or left main–equivalent disease. (I-C) | C0002962,C0003842,C0009814,C0010055,C0012634,C0181074,C0185098,C0205042,C0332835,C0440761,C0581603,C0741847,C1261287,C1269008,C1273869 | 1006582 |
| 32642 | Coronary artery revascularization via coronary artery bypass graft to improve survival is reasonable in patients with mild to moderate LV systolic dysfunction (EF 35%–50%) and significant (?70% diameter stenosis) multivessel CAD or proximal left anterior descending (LAD) coronary artery stenosis when viable myocardium is present in the region of intended revascularization. (IIa-B) | C0003842,C0009814,C0010055,C0027061,C0181074,C0185098,C0205042,C0242231,C0332835,C0440761,C0581603,C0741847,C0749225,C1261287,C1269008 | 1006582 |
| 32643 | CABG or medical therapy is reasonable to improve morbidity and cardiovascular mortality for patients with severe LV dysfunction (EF <35%), HF, and significant CAD. | C0087111,C0418981 | 97139 |
| 32644 | Surgical aortic valve replacement is reasonable for patients with critical aortic stenosis and a predicted surgical mortality of <10%. (IIa-B) | C0003483,C0003501,C0003506,C0003507,C0009814,C0035139,C0543467,C1261287,C1269005 | 1003143,1006151 |
| 32645 | Transcatheter aortic valve replacement after careful candidate consideration is reasonable for patients with critical aortic stenosis who are deemed inoperable. (IIa-B) | C0003483,C0003501,C0003506,C0003507,C0009814,C0035139,C1261287,C1269005 | 1006151 |
| 32646 | CABG may be considered with the intent of improving survival in patients with ischemic heart disease with severe LV systolic dysfunction (EF <35%) and operable coronary anatomy whether or not viable myocardium is present. (IIb-B) | C0012634,C0018787,C0018799,C0027061,C0151744,C0749225,C1281570 | |
| 32647 | Transcatheter mitral valve repair or mitral valve surgery for functional mitral insufficiency is of uncertain benefit and should only be considered after careful candidate selection and with a background of GDMT. | C0026264,C0026266,C0374711,C0543467,C1269004 | 1003143 |
| 32648 | Surgical reverse remodeling or LV aneurysmectomy may be considered in carefully selected patients with HFrEF for specific indications including intractable HF and ventricular arrhythmias. | C0003811,C0085612,C0189598,C0543467 | 1003143 |
| 32649 | Effective systems of care coordination with special attention to care transitions should be deployed for every patient with chronic HF that facilitate and ensure effective care that is designed to achieve GDMT and prevent hospitalization. | C0309872 | |
| 32650 | Every patient with HF should have a clear, detailed, and evidencebased plan of care that ensures the achievement of GDMT goals, effective management of comorbid conditions, timely follow-up with the healthcare team, appropriate dietary and physical activities, and compliance with secondary prevention guidelines for cardiovascular disease. This plan of care should be updated regularly and made readily available to all members of each patient’s healthcare team. (I-C) | C0007222,C0012634,C0199176,C0277555,C0589120,C0679699,C1275743 | |
| 32651 | Palliative and supportive care is effective for patients with symptomatic advanced HF to improve quality of life. (I-B) | C0030231,C0344211,C0518214 | |
| 32653 | Participation in quality improvement programs and patient registries based on nationally endorsed, clinical practice guideline–based quality and performance measures can be beneficial in improving quality of HF care. | C2728259 | |
| 32654 | We suggest noninvasive sampling with semiquantitative cultures to diagnose VAP, rather than invasive sampling with quantitative cultures and rather than noninvasive sampling with quantitative cultures | C0441621,C2242979 | |
| 32655 | Noninvasive sampling with semiquantitative cultures is the preferred methodology to diagnose VAP (see section I); however, the panel recognizes that invasive quantitative cultures will occasionally be performed by some clinicians. For patients with suspected VAP whose invasive quantitative culture results are below the diagnostic threshold for VAP, we suggest that antibiotics be withheld rather than continued | C0003232,C0441621,C2242979 | |
| 32656 | We suggest that patients with suspected HAP (non-VAP) be treated according to the results of microbiologic studies performed on respiratory samples obtained noninvasively, rather than being treated empirically | C0444279 | |
| 32657 | For patients with suspected HAP/VAP, we recommend using clinical criteria alone, rather than using serum PCT plus clinical criteria, to decide whether or not to initiate antibiotic therapy | C0003232,C0087111,C0162566,C0229671,C0338237 | 97139 |
| 32658 | For patients with suspected HAP/VAP, we recommend using clinical criteria alone, rather than using bronchoalveolar lavage fluid (BALF) sTREM-1 plus clinical criteria, to decide whether or not to initiate antibiotic therapy | C0003232,C0006279,C0022100,C0087111,C0338237,C1535502 | 97139 |
| 32659 | For patients with suspected HAP/VAP, we recommend using clinical criteria alone rather than using CRP plus clinical criteria, to decide whether or not to initiate antibiotic therapy | C0003232,C0006560,C0087111,C0338237 | 97139 |
| 32660 | For patients with suspected HAP/VAP, we suggest using clinical criteria alone, rather than using CPIS plus clinical criteria, to decide whether or not to initiate antibiotic therapy | C0003232,C0087111,C0338237 | 97139 |
| 32661 | In patients with VAT, we suggest not providing antibiotic therapy | C0003232,C0087111,C0338237 | 97139 |
| 32662 | In patients with suspected VAP, we recommend including coverage for S. aureus, Pseudomonas aeruginosa, and other gram-negative bacilli in all empiric regimens | C0449210 | |
| 32663 | We suggest including an agent active against MRSA for the empiric treatment of suspected VAP only in patients with any of the following: a risk factor for antimicrobial resistance (Table 2), patients being treated in units where >10%–20% of S. aureus isolates are methicillin resistant, and patients in units where the prevalence of MRSA is not known | C0450442 | |
| 32664 | We suggest including an agent active against methicillinsensitive S. aureus (MSSA) (and not MRSA) for the empiric treatment of suspected VAP in patients without risk factors for antimicrobial resistance, who are being treated in ICUs where <10%–20% of S. aureus isolates are methicillin resistant (weak recommendation, very low-quality evidence). | C0442811,C0450442 | |
| 32666 | When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (weak recommendation, very low-quality evidence). Oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven MSSA, but are not necessary for the empiric treatment of VAP if one of the above agents is used. | C0007546,C0020933,C0027324,C0029983,C0031955,C0055003,C0066005,C0075870,C0282386,C0450442 | |
| 32667 | Oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven MSSA, but are not necessary for the empiric treatment of VAP if one of the above agents is used | C0007546,C0027324,C0029983,C0450442 | |
| 32668 | We suggest prescribing 2 antipseudomonal antibiotics from different classes for the empiric treatment of suspected VAP only in patients with any of the following: a risk factor for antimicrobial resistance (Table 2), patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy, and patients in an ICU where local antimicrobial susceptibility rates are not available | C0003232,C0427965,C0450442 | |
| 32669 | We suggest prescribing one antibiotic active against P. aeruginosa for the empiric treatment of suspected VAP in patients without risk factors for antimicrobial resistance who are being treated in ICUs where ?10% of gram-negative isolates are resistant to the agent being considered for monotherapy | C0003232,C0450442 | |
| 32670 | In patients with suspected VAP, we suggest avoiding aminoglycosides if alternative agents with adequate gram-negative activity are available | C0002556,C0450442 | |
| 32671 | In patients with suspected VAP, we suggest avoiding colistin if alternative agents with adequate gram-negative activity are available | C0009316,C0450442 | |
| 32672 | For patients being treated empirically for HAP, we recommend prescribing an antibiotic with activity against S. aureus | C0003232 | |
| 32673 | For patients with HAP who are being treated empirically and have either a risk factor for MRSA infection (ie, prior intravenous antibiotic use within 90 days, hospitalization in a unit where >20% of S. aureus isolates are methicillin resistant, or the prevalence of MRSA is not known, or who are at high risk for mortality, we suggest prescribing an antibiotic with activity against MRSA | C0003232,C0343401 | |
| 32674 | For patients with HAP who require empiric coverage for MRSA, we recommend vancomycin or linezolid rather than an alternative antibiotic | C0003232,C0042313,C0663241 | |
| 32675 | For patients with HAP who are being treated empirically and have no risk factors for MRSA infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against MSSA. When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. Oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven MSSA, but are not necessary for empiric coverage of HAP if one of the above agents is used | C0003232,C0007546,C0020933,C0027324,C0029983,C0031955,C0055003,C0066005,C0075870,C0282386,C0343401,C0450442 | |
| 32676 | When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. Oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven MSSA, but are not necessary for empiric coverage of HAP if one of the above agents is used | C0007546,C0020933,C0027324,C0029983,C0031955,C0055003,C0066005,C0075870,C0282386,C0450442 | |
| 32677 | For patients with HAP who are being treated empirically, we recommend prescribing antibiotics with activity against P. aeruginosa and other gram-negative bacilli | C0003232,C0449210 | |
| 32678 | For patients with HAP who are being treated empirically and have factors increasing the likelihood for Pseudomonas or other gram-negative infection (ie, prior intravenous antibiotic use within 90 days; also see Remarks) or a high risk for mortality, we suggest prescribing antibiotics from 2 different classes with activity against P. aeruginosa | C0003232,C0449210 | |
| 32679 | For patients with HAP who are being treated empirically, we recommend not using an aminoglycoside as the sole antipseudomonal agent | C0450442 | |
| 32680 | For patients with HAP/VAP, we suggest that antibiotic dosing be determined using PK/PD data, rather than the manufacturer’s prescribing information | C0003232 | |
| 32681 | For patients with VAP due to gram-negative bacilli that are susceptible to only aminoglycosides or polymyxins (colistin or polymyxin B), we suggest both inhaled and systemic antibiotics, rather than systemic antibiotics alone | C0002556,C0003232,C0009316,C0032535,C0032539 | |
| 32682 | We recommend that MRSA HAP/VAP be treated with either vancomycin or linezolid rather than other antibiotics or antibiotic combinations | C0003232,C0042313,C0356164,C0449210,C0663241 | |
| 32683 | For patients with HAP/VAP due to P. aeruginosa, we recommend that the choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing | C0003232,C0087111,C0201179,C0427965 | 97139 |
| 32684 | For patients with HAP/VAP due to P. aeruginosa, we recommend against aminoglycoside monotherapy (strong recommendation, very low-quality evidence). | C0442811 | |
| 32685 | For patients with HAP/VAP due to P. aeruginosa who are not in septic shock or at a high risk for death, and for whom the results of antibiotic susceptibility testing are known, we recommend monotherapy using an antibiotic to which the isolate is susceptible rather than combination therapy | C0003232,C0036974,C0036983,C0087111,C0427965,C0556895,C1306577 | 97139 |
| 32686 | For patients with HAP/VAP due to P. aeruginosa who remain in septic shock or at a high risk for death when the results of antibiotic susceptibility testing are known, we suggest combination therapy using 2 antibiotics to which the isolate is susceptible rather than monotherapy | C0003232,C0036974,C0036983,C0087111,C0427965,C0556895,C1306577 | 97139 |
| 32688 | For patients with HAP/VAP due to ESBL-producing gramnegative bacilli, we recommend that the choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing and patient-specific factors | C0003232,C0087111,C0427965 | 97139 |
| 32689 | In patients with HAP/VAP caused by Acinetobacter species, we suggest treatment with either a carbapenem or ampicillin/sulbactam if the isolate is susceptible to these agents | C0002680,C0006968,C0038665,C0450442 | |
| 32690 | In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins, we recommend intravenous polymyxin (colistin or polymyxin B) | C0009316,C0032539 | |
| 32691 | In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin | C0009316,C0032539 | |
| 32692 | In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to colistin, we suggest not using adjunctive rifampicin | C0009316,C0035608 | |
| 32693 | In patients with HAP/VAP caused by Acinetobacter species, we recommend against the use of tigecycline | C1260298 | |
| 32694 | In patients with HAP/VAP caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we recommend intravenous polymyxins (colistin or polymyxin B) | C0006968,C0009316,C0032539 | |
| 32695 | In patients with HAP/VAP caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin | C0006968,C0009316,C0032539 | |
| 32696 | For patients with VAP, we recommend a 7-day course of antimicrobial therapy rather than a longer duration | C0087111,C2926735 | 97139 |
| 32697 | For patients with HAP, we recommend a 7-day course of antimicrobial therapy | C0087111 | 97139 |
| 32698 | For patients with HAP/VAP, we suggest that antibiotic therapy be de-escalated rather than fixed | C0003232,C0087111,C0338237 | 97139 |
| 32699 | For patients with HAP/VAP, we suggest using PCT levels plus clinical criteria to guide the discontinuation of antibiotic therapy, rather than clinical criteria alone | C0003232,C0087111,C0162566,C0338237,C0457454,C2946261 | 97139 |
| 32700 | For patients with suspected HAP/VAP, we suggest not using the CPIS to guide the discontinuation of antibiotic therapy | C0003232,C0087111,C0338237,C0457454 | 97139 |
| 32701 | Gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma are recommended to help identify whether Staphylococcus aureus and/or a ?-hemolytic streptococcus is the cause | C0013568,C0015388,C0021099,C0034161,C0037284,C0038128,C0061856,C0200966,C0221198,C1123023,C1278993,C2242979 | |
| 32702 | Treatment without gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma is reasonable in typical cases | C0013568,C0015388,C0021099,C0034161,C0037284,C0038128,C0061856,C0200966,C0221198,C1123023,C1278993,C2242979 | |
| 32703 | Treatment of bullous and nonbullous impetigo should be with either mupirocin or retapamulin bid for 5 days | C0021099,C0021100,C0085259,C1703334 | |
| 32704 | Oral therapy for ecthyma or impetigo should be a 7-day regimen with an agent active against S. aureus unless cultures yield streptococci alone (when oral penicillin is the recommended agent) | C0013568,C0021099,C0030842,C0087111,C0220892,C0450442,C2242979 | 97139 |
| 32705 | Because Staphylococcus aureus isolates from impetigo and ecthyma are usually methicillin-susceptible, dicloxacillin or cephalexin is recommended. | C0007716,C0012093,C0013568,C0021099,C0025643 | |
| 32706 | When methicillin-resistant Staphylococcus aureus is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim is recommended | C0008947,C0013090,C0025643,C0038689,C0041041,C0343401 | |
| 32707 | Systemic antimicrobials should be used for infections during outbreaks of post-streptococcal glomerulonephritis to help eliminate nephritogenic strains of Streptococcus pyogenes from the community | C0017658,C0080194,C0403414 | |
| 32708 | Gram stain and culture of pus from carbuncles and abscesses are recommended, but treatment without these studies is reasonable in typical cases | C0000833,C0007078,C0034161,C0038128,C0061856,C0200966,C2242979 | |
| 32709 | Gram stain and culture of pus from inflamed epidermoid cysts are NOT recommended | C0010709,C0014511,C0034161,C0038128,C0061856,C0200966,C2242979 | |
| 32710 | Incision and drainage is the recommended treatment for inflamed epidermoid cysts, carbuncles, abscesses and large furuncles | C0000833,C0007078,C0010709,C0012621,C0013103,C0014511,C0152277,C0184898,C0242301 | |
| 32711 | The decision to administer antibiotics directed against S. aureus as an adjunct to incision and drainage should be made based on the presence or absence of systemic inflammatory response syndrome (SIRS) such as temperature >38°C or <36°C, tachypnea >24 breaths/min, tachycardia >90 beats/min or white blood cell count (WBC) >12,000 or <4000 cells/mm3 | C0003232,C0005767,C0005771,C0005773,C0007584,C0007634,C0012621,C0013103,C0023508,C0023516,C0039082,C0039231,C0184898,C0225386,C0231835,C0242966,C0392148,C1269647,C1689985 | 1011761,85004 |
| 32712 | An antibiotic active against MRSA is recommended for patients with carbuncles or abscesses who have failed initial antibiotic treatment, have markedly impaired host defenses, or in patients with SIRS and hypotension | C0000833,C0003232,C0007078,C0020649 | |
| 32713 | A recurrent abscess at a site of previous infection should prompt a search for local causes such as a pilonidal cyst, hidradenitis suppurativa or foreign material | C0000833,C0010709,C0016542,C0031925,C0085160,C0162836 | |
| 32714 | Recurrent abscesses should be drained and cultured early in the course of infection | C0000833 | |
| 32715 | After obtaining cultures of recurrent abscess, treat with a 5- to 10-day course of an antibiotic active against the pathogen isolated | C0000833,C0003232,C2242979 | |
| 32716 | Consider a 5-day decolonization regimen of intranasal mupirocin bid, daily chlorhexidine washes, and daily decontamination of personal items such as towels, sheets, and clothes for recurrent S. aureus infection ( | C0008196,C0011121,C0085259 | |
| 32717 | Adult patients should be evaluated for neutrophil disorders if recurrent abscesses began in early childhood | C0000833,C0012634,C0027950 | |
| 32718 | Cultures of blood or cutaneous aspirates, biopsies, or swabs are NOT routinely recommended | C0005767,C0370199,C1261188,C2242979 | |
| 32719 | Cultures of blood are recommended in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites | C0003044,C0005658,C0005767,C0007634,C0013216,C0021051,C0027947,C0038561,C0392920,C1269647,C1302713,C1306459,C2242979 | |
| 32720 | cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites ( | C0003044,C0005658,C0007634,C0013216,C0021051,C0026018,C0027947,C0031809,C0038561,C0370199,C0392920,C1261188,C1269647,C1302713,C1306459,C2242979 | 1014526 |
| 32721 | Typical cases of cellulitis without systemic signs of infection should receive an antimicrobial agent that is active against streptococci | C0007642,C0243026,C0311392,C0450442 | |
| 32722 | For cellulitis with systemic signs of infection (See Fig. 1/Nonpurulent/MODERATE) systemic antibiotics are indicated. Many clinicians could include coverage against methicillin-susceptible S. aureus (MSSA) ( | C0003232,C0007642,C0025643,C0243026,C0311392 | |
| 32723 | For patients whose cellulitis is associated with penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, or SIRS vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended | C0007642,C0013227,C0028429,C0042313,C0043251,C0343401,C1272883,C1533685,C3263723 | 1003714,1003717 |
| 32724 | In severely compromised patients (patients who have failed oral antibiotic treatment or those with systemic signs of infection (such as temperature >38°C, tachycardia (heart rate >90 beats per minute), tachypnea (respiratory rate >24 breaths per minute) or abnormal white blood cell count (<12 000 or <400 cells/?L), or those who are immunocompromised,or those with clinical signs of deeper infection such as bullae, skin sloughing, hypotension, or evidence of organ dysfunction) broad-spectrum antimicrobial coverage may be considered | C0003232,C0005758,C0005767,C0005771,C0005773,C0007584,C0007634,C0018787,C0020649,C0023508,C0023516,C0027544,C0039231,C0152009,C0225386,C0231835,C0243026,C0275521,C0311392,C0333717,C0333794,C0449201,C1123023,C1269647,C1278993,C1281570,C1294063 | 1011761,85004 |
| 32725 | Vancomycin plus either piperacillin-tazobactam or imipenem/meropenem is recommended as a reasonable empiric regimen for severe infections | C0020933,C0031955,C0042313,C0066005,C0075870 | |
| 32726 | The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period | C0087111,C2926735 | 97139 |
| 32727 | Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended | C0012634,C0013604,C0439775 | |
| 32728 | In lower extremity cellulitis, clinicians should carefully examine the interdigital toe spaces because treating fissuring, scaling, or maceration may eradicate colonization with pathogens and reduce the incidence of recurrent infection | C0007642,C0015385,C0023216,C0040357,C0237849,C0278456,C0333525,C1281539,C1281589 | |
| 32729 | Outpatient therapy is recommended for patients who do not have SIRS, altered mental status, or hemodynamic instability | C0087111,C0278060,C0948268,C1444783 | 97139 |
| 32730 | Hospitalization is recommended if there is concern for a deeper or necrotizing infection, for patients with poor adherence to therapy, for infection in a severely immunocompromised patient or if outpatient treatment is failing | C0087111 | 97139 |
| 32731 | Systemic corticosteroids (eg, prednisone 40 mg daily for 7 days) could be considered in nondiabetic adult patients with cellulitis | C0001617,C0007642,C0032952,C1382730 | |
| 32732 | Identify and treat predisposing conditions such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities. These practices should be performed as part of routine patient care and certainly during the acute stage of cellulitis. | C0007642,C0013595,C0013604,C0028754,C0040357,C0230506,C0332875,C1281589 | |
| 32733 | Administration of prophylactic antibiotics, such as oral penicillin or erythromycin bid for 4-52 weeks, or intramuscular benzathine penicillin every 2-4 weeks should be considered in patients who have 3-4 episodes of cellulitis per year despite attempts to treat or control predisposing factors | C0003232,C0007642,C0014806,C0030829,C0030842,C0199779,C0220892,C0308718,C0360341,C1533734 | |
| 32734 | This program should be continued so long as the predisposing factors persist | C2728259 | |
| 32735 | Suture removal plus incision and drainage should be performed for surgical site infections | C0012621,C0013103,C0015252,C0038969,C0184898,C0543467 | 1003143 |
| 32736 | Adjunctive systemic antimicrobial therapy is NOT routinely indicated but in conjunction with incision and drainage may be beneficial for surgical site infections associated with a significant systemic response such as erythema and induration extending >5 cm from the wound edge, temperature >38.5ºC, heart rate >110/min, or WBC count >12,000/mm3 | C0012621,C0013103,C0018787,C0023508,C0041834,C0043250,C0087111,C0184898,C0332534,C0543467,C1281570 | 1003143,85004,97139 |
| 32737 | A brief course of systemic antimicrobial therapy is indicated in patients with surgical site infections after clean operations on the trunk, head and neck, or extremities that also have systemic signs of infection | C0018670,C0027530,C0087111,C0185774,C0243026,C0311392,C0460004,C0460005,C0543467,C1280632,C1281590,C1281592,C1283900 | 1003143,97139 |
| 32738 | A first-generation cephalosporin or an anti-staphylococcal penicillin for MSSA or vancomycin, linezolid, daptomycin, telavancin or ceftaroline where risk factors for MRSA are high (nasal colonization, prior MRSA infection, recent hospitalization, recent antibiotics) is recommended | C0003232,C0028429,C0030842,C0042313,C0057144,C0220892,C0304317,C0343401,C0663241,C1453642,C2001521,C2266959 | |
| 32739 | Agents active against Gram-negative bacteria and anaerobes, such as a cephalosporin or fluoroquinolone in combination with metronidazole, are recommended for infections after operations on the axilla, gastrointestinal (GI) tract, perineum or female genital tract | C0004454,C0017421,C0025872,C0031066,C0450442,C0543467,C0559522,C0700038,C1279154,C1280088,C1283835,C1284953,C2266959 | 1003143 |
| 32740 | Prompt surgical consultation is recommended for patients with aggressive infections associated with signs of systemic toxicity or suspicion of necrotizing fasciitis or gas gangrene | C0009818,C0015645,C0017086,C0017105,C0017110,C0238124,C0311392,C0543467,C0600688,C1602245,C1704673 | 1003143,1013686 |
| 32741 | Empiric antibiotic treatment should be broad (eg, vancomycin or linezolid plus piperacillin-tazobactam or plus a carbapenem; or plus ceftriaxone and metronidazole), since the etiology can be polymicrobial (mixed aerobic-anaerobic microbes) or monomicrobial (Group A streptococcus, community-acquired MRSA) | C0003232,C0006968,C0007561,C0025872,C0031955,C0042313,C0075870,C0663241 | |
| 32742 | Penicillin plus clindamycin is recommended for treatment of documented Group A streptococcal necrotizing fasciitis | C0008947,C0015645,C0030842,C0220892,C0238124,C0854084 | |
| 32743 | Magnetic resonance imaging (MRI) is the recommended imaging modality for establishing the diagnosis of pyomyositis. Computed tomography (CT) scan and ultrasound studies are also useful. | C0011900,C0011923,C0024485,C0040395,C0040405,C0041618,C0231881,C1704275 | 1010759,76497,76498,76999 |
| 32744 | Cultures of blood and abscess material should be obtained | C0000833,C0005767,C2242979 | |
| 32745 | Vancomycin is recommended for initial empiric therapy. An agent active against enteric Gram-negative bacilli should be added for infection in immunocompromised patients or after open trauma to the muscles (SR-M). | C0026845,C0042313,C0043251,C0087111,C0450442,C3263723 | 97139 |
| 32746 | Cefazolin or antistaphylococcal penicillin (eg, nafcillin or oxacillin) is recommended for treatment of pyomyositis caused by MSSA (SR-M). | C0007546,C0027324,C0029983,C0030842,C0220892,C1704275 | |
| 32747 | Early drainage of purulent material should be performed | C0012621,C0013103 | |
| 32748 | Repeat imaging studies should be performed in patients with persistent bacteremia to identify undrained foci of infection | C0004610,C0011923 | |
| 32749 | Antibiotics should be administered intravenously initially, but once the patient is clinically improved oral antibiotics are appropriate for patients in whom bacteremia cleared promptly and there is no evidence of endocarditis or metastatic abscess. Two to three weeks of therapy is recommended. | C0000833,C0003232,C0004610,C0014118,C0087111 | 97139 |
| 32750 | Urgent surgical exploration of the suspected gas gangrene site and surgical debridement of involved tissue should be performed | C0011079,C0017086,C0017105,C0017110,C0040300,C0184899,C0543467,C1280903,C1704673 | 1003143 |
| 32751 | In the absence of a definitive etiologic diagnosis, broad-spectrum treatment with vancomycin plus either piperacillin/tazobactam, ampicillin/sulbactam or a carbapenem antimicrobial is recommended (SR-L). | C0002680,C0006968,C0011900,C0031955,C0038665,C0042313,C0075870,C1689985 | |
| 32752 | Definitive antimicrobial therapy with penicillin and clindamycin is recommended for treatment of clostridial myonecrosis (SR-L). | C0008947,C0017105,C0030842,C0087111,C0220892 | 97139 |
| 32753 | Hyperbaric oxygen therapy is NOT recommended because it has not been proven as a benefit to patients and may delay resuscitation and surgical debridement (SR-L). | C0011079,C0020431,C0030054,C0035273,C0087111,C0184633,C0543467 | 1003143,97139 |
| 32754 | Preemptive early antimicrobial therapy for 3-5 days is recommended for patients who: a) are immunocompromised; b) are asplenic; c) have advanced liver disease; d) have preexisting or resultant edema of the affected area; e) have moderate to severe injuries, especially to the hand or face; or f) have injuries that may have penetrated the periosteum or joint capsule (SR-L). | C0006935,C0012634,C0013604,C0015450,C0018563,C0022417,C0023884,C0023895,C0031110,C0087111,C1269611,C1278929,C1281583,C1281591 | 97139 |
| 32755 | Postexposure prophylaxis for rabies may be indicated. Consultation with local health officials is recommended to determine if vaccination should be initiated (SR-L). | C0009818,C0034494,C0042196,C0199176 | 1013686,90749 |
| 32756 | An antimicrobial agent or agents active against both aerobic and anaerobic bacteria such as amoxicillin-clavulanate should be used | C0002645,C0110038,C0450442 | |
| 32757 | Tetanus toxoid should be administered to patients without toxoid vaccination within 10 years. Tdap is preferred over Td if the former has not been previously given (SR-L). | C0039614,C0039620,C0040555,C0042196,C0305060,C0305062 | 90749 |
| 32758 | Primary wound closure is NOT recommended for wounds, with the exception of those to the face, which should be managed with copious irrigation, cautious debridement and preemptive antibiotics. | C0003232,C0011079,C0015450,C0022100,C0043250,C0185003,C0439631,C0441503,C1281591 | |
| 32759 | Other wounds may be approximated (WR-L). | C0043250,C0449210 | |
| 32760 | Oral penicillin V 500 mg qid for 7-10 days is the recommended treatment for naturally acquired cutaneous anthrax (SR-H). | C0003175,C0003177,C0030840,C0030842,C0220892,C1125626 | |
| 32761 | Ciprofloxacin 500 mg PO bid or levofloxacin 500 mg IV/PO q24h for 60 days is recommended for bioterrorism cases because of presumed aerosol exposure. | C0008809,C0150009,C0150032,C0150061,C0150082,C0231357,C0231359,C0231379,C0231393,C0231416,C0231418,C0274281,C0282386,C0582147,C0582456,C0992502,C1112870,C1123173 | |
| 32762 | Azithromycin is recommended for cat scratch disease. Patients >45 kg, 500 mg on day 1 followed by 250 mg for 4 additional days. Patients <45 kg, 10 mg/kg on day 1 and 5 mg/kg for 4 more days | C0007361,C0012634,C0052796,C0238909,C1384489 | |
| 32763 | Erythromycin 500 mg qid or doxycycline 100 mg bid for 2 weeks to 2 months is recommended for treatment of bacillary angiomatosis (SR-M). | C0002992,C0013090,C0014806,C0085434,C1123142,C1374596 | |
| 32764 | Penicillin 500 mg qid or amoxicillin 500 mg tid for 7-10 days is recommended for treatment of erysipeloid (SR-H). | C0002645,C0014736,C0030842,C0220892,C0993263,C1276801 | |
| 32765 | Ceftazidime, gentamicin, imipenem, doxycycline or ciprofloxacin is recommended based on in vitro susceptibility (SR-L). | C0007559,C0008809,C0013090,C0017436,C0020933 | |
| 32766 | Bubonic plague should be diagnosed by Gram stain and culture of aspirated material from a suppurative lymph node | C0024202,C0024204,C0032064,C0038128,C0061856,C0200966,C0282312,C1269047,C2242979,C3249881 | |
| 32767 | Streptomycin 15 mg/kg IM q12h or doxycycline 100 mg bid PO is recommended for treatment of bubonic plague (SR-L). | C0013090,C0032064,C0038425,C0150009,C0150032,C0150061,C0150082,C0231357,C0231359,C0231377,C0231379,C0231393,C0231416,C0231418,C0282312,C0582147,C0582456,C1123142 | |
| 32769 | Serologic tests are the preferred method of diagnosing tularemia (WR-L). | C0036743,C0041351 | |
| 32770 | Streptomycin 15 mg/kg q12h IM or gentamicin 1.5 mg/kg q8h IV is recommended for treatment of severe cases of tularemia (SR-L). | C0017436,C0038425,C0041351,C0231377 | |
| 32771 | Tetracycline 500 mg qid or doxycycline 100 mg bid PO is recommended for treatment of mild cases of tularemia (SR-L). | C0013090,C0039644,C0041351,C0150009,C0150032,C0150061,C0150082,C0231357,C0231359,C0231379,C0231393,C0231416,C0231418,C0582147,C0582456,C1123142,C1123624 | |
| 32772 | Notify the microbiology laboratory if tularemia is suspected (SR-H). | C0041351,C0085672 | 1012134,87999 |
| 32773 | In addition to infection, differential diagnosis of skin lesions should include drug eruption, cutaneous infiltration with the underlying malignancy, chemotherapy- or radiation-induced reactions, Sweet’s syndrome, erythema multiforme, leukocytoclastic vasculitis and graftversus-host disease among allogeneic transplant recipients (SR-H). | C0011609,C0011900,C0011906,C0012634,C0013216,C0013227,C0014742,C0015230,C0037284,C0039082,C0040732,C0041834,C0042384,C0151436,C0221198,C0302295,C0332448,C0332835,C0392920,C0702249,C1123023,C1278993,C1306459,C2973529 | |
| 32774 | Differential diagnosis for infection of skin lesions should include bacterial, fungal, viral and parasitic agents (SR-H). | C0011900,C0011906,C0037278,C0037284,C0221198,C0304207,C0450442,C1123023,C1268919,C1278993 | |
| 32775 | Biopsy or aspiration of the lesion to obtain material for histologic and microbiologic evaluation should always be implemented as an early diagnostic step (SR-H). | C0005558,C0220787,C0221198,C0349707,C0700198,C1261322 | |
| 32776 | Determine whether the current presentation of fever and neutropenia is the patient’s initial episode of fever and neutropenia or a persistent unexplained fever from their initial episode (after 4-7 days), or a subsequent episode of fever and neutropenia (recurrent) | C0015967,C0027947 | |
| 32777 | Aggressively determine the etiology of the skin and soft tissue infection by aspiration and/or biopsy of skin and soft tissue lesions and submit these for thorough cytologic/histologic assessments, microbial staining and cultures | C0005558,C0037278,C0038128,C0040300,C0149778,C0150866,C0200965,C0220787,C0221198,C0225317,C0349707,C0410013,C0684084,C0700198,C1123023,C1261322,C1278993,C1298701,C2242979 | 1003188 |
| 32778 | Risk-stratify patients with fever and neutropenia according to susceptibility to infection: high-risk patients are those with anticipated prolonged (>7 days) and profound neutropenia (ANC <100 cells/?L) or with a Multinational Association for Supportive Care (MASCC) score of <21; low-risk patients are those with anticipated brief (<7 days) periods of neutropenia and few comorbidities or with a MASCC of ?21 | C0007634,C0015967,C0027947,C0344211,C1269647 | |
| 32779 | Determine the extent of infection through a thorough physical examination, blood cultures, chest radiograph and additional imaging (including chest CT) | C0005767,C0011923,C0031809,C0200949,C0202823,C0817096,C1306645,C2242979 | 1014526,71250 |
| 32780 | Hospitalization and empiric antibacterial therapy with vancomycin plus antipseudomonal antibiotics such as cefepime, a carbapenem (imipenem-cilastatin or meropenem or doripenem) or piperacillintazobactam are recommended | C0003232,C0006968,C0008777,C0020933,C0042313,C0055003,C0066005,C0087111,C0279516,C0389169 | 97139 |
| 32781 | Documented clinical and microbiologic skin and soft tissue infections should be treated based on antimicrobial susceptibilities of isolated organisms | C0037278,C0040300,C0149778,C0225317,C0684084,C1123023,C1278993 | |
| 32782 | The treatment duration for most bacterial skin and soft tissue infections should be 7-14 days | C0004623,C0037278,C0040300,C0149778,C0225317,C0684084,C1123023,C1278993,C2926735 | |
| 32783 | Surgical intervention is recommended for drainage of soft-tissue abscess after marrow recovery or for a progressive polymicrobial necrotizing fasciitis or myonecrosis | C0000833,C0012621,C0013103,C0015645,C0040300,C0225317,C0344096,C0543467,C1273869 | 1003143,10060,1007123,1007126 |
| 32784 | Adjunct colony-stimulating factor therapy (G-CSF, GM-CSF) or granulocyte transfusions | C0018183,C0087111,C1879316 | 97139 |
| 32785 | Acyclovir should be administered to patients suspected or confirmed to have cutaneous or disseminated herpes simplex (HSV) or varicella zoster virus (VZV) infection (SR-M). | C0001367,C0008049,C0019348,C0019360 | |
| 32786 | Yeasts and molds remain the primary cause of infection-associated fever and neutropenia. Therefore, empiric antifungal therapy (Table 5) should be added to the antibacterial regimen (SR-H). | C0003308,C0015967,C0027947,C0087111,C0279516,C0439631 | 97139 |
| 32787 | Empiric administration of vancomycin or other agents with Gram-positive activity (linezolid, daptomycin or ceftaroline) should be added if not already being administered | C0042313,C0057144,C0449210,C0450442,C0663241,C1533734,C2001521 | |
| 32788 | Candida species skin and soft tissue infections should be treated with an echinocandin or, if Candida parapsilosis has been isolated, lipid formulation amphotericin-B (SR-H) | C0002679,C0006840,C0023779,C0037278,C0040300,C0085795,C0149778,C0225317,C0684084,C1123023,C1268551,C1278993 | |
| 32789 | if Candida parapsilosis has been isolated treat with fluconazole as an acceptable alternative to lipid formulation amphotericin-B | C0002679,C0016277,C0023779,C0085795 | |
| 32790 | Treatment should be for 2 weeks after clearance of blood stream infection or resolution of skin lesions. | C0005767,C0037284,C0221198,C1123023,C1278993 | |
| 32791 | Aspergillus skin and soft tissue infections should be treated with voriconazole | C0037278,C0040300,C0149778,C0225317,C0393080,C0684084,C1123023,C1278993 | |
| 32792 | alternatively to voriconazole treat Aspergillus skin and soft tissue infections with lipid formulations of amphotericin B, posaconazole or echinocandin for 6-12 weeks | C0002679,C0023779,C0037278,C0040300,C0085795,C0149778,C0225317,C0393080,C0684084,C0936148,C1123023,C1268551,C1278993 | |
| 32793 | Mucor/Rhizopus infections should be treated with lipid formulation amphotericin B | C0002679,C0023779,C0085795 | |
| 32794 | Mucor/Rhizopus infections should be treated with posaconazole | C0936148 | |
| 32795 | The addition of an echinocandin could be considered based on synergy in murine models of mucormycosis and observational clinical data (WR-L). | C0026718,C1268551 | |
| 32796 | Fusarium species infections should be treated with high-dose IV voriconazole or posaconazole | C0276758,C0393080,C0936148 | |
| 32798 | Intravenous acyclovir should be added to the patient’s antimicrobial regimen for suspected or confirmed cutaneous or disseminated HSV or VZV infections (SR-M). | C0001367 | |
| 32799 | Blood cultures should be obtained, and skin lesions in this population of patients should be aggressively evaluated by culture aspiration, biopsy or surgical excision since they may be caused by resistant microbes, yeast or molds | C0005558,C0005767,C0037284,C0200949,C0220787,C0221198,C0349707,C0543467,C0700198,C0728940,C1123023,C1278993,C2242979 | 1003143,1004869 |
| 32800 | Polymerase chain reaction (PCR) in peripheral blood for HSV and VZV might be helpful in establishing a diagnosis of disseminated infection in patients with unexplained skin lesions (WR-M). | C0005767,C0011900,C0032520,C0037284,C0221198,C0229664,C1123023,C1278993 | |
| 32801 | Consider immediate consultation with a dermatologist familiar with cutaneous manifestations of infection in patients with cellular immune defects (eg, those with lymphoma, lymphocytic leukemia, recipients of organ transplants, or those receiving immunosuppressive drugs such as anti-tumor necrosis factors or certain monoclonal antibodies) | C0009818,C0013227,C0023418,C0023448,C0024299,C0040732,C0301889,C0332835,C1533651 | 1013686 |
| 32802 | Consider biopsy and surgical debridement early in the management of these patients | C0005558,C0011079,C0543467 | 1003143 |
| 32804 | The use of specific agents should be decided with the input of the primary team, dermatology, infectious disease and other consulting teams | C0009450,C0012634,C0439631,C0449210,C0450442 | |
| 32805 | In patients with a suspected or known abdominal aortic aneurysm (AAA), the SVS recommends performing physical examination that includes an assessment of femoral and popliteal arteries. | C0000726,C0002940,C0003483,C0003486,C0015811,C0031809,C0162871,C0442037,C1261322 | 1014526 |