Ambulatory management of haemodialysis lines with Staph aureus bloodstream infections
Includes: peripheral intravascular cannula, peripherally inserted central catheter (PICC), central intravascular catheter, permanent pacemakers, implanted defibrillator.
- Consult Micro/ID.
- Device removal is a priority, where possible.
- Salvage therapy can ONLY be attempted when all of the following criteria are met:
- the device cannot be removed,
- there is no evidence of tunnel or exit site infection,
- the patient is stable,
- the organisms are amenable to salvage treatment.
- Consider line lock where line cannot be removed, following discussion with Micro/ID. See Preparing and administering Antimicrobial line locks.
- Take blood cultures peripherally and from intravascular line prior to treatment.
- Therapy should be tailored to microbiology results from cultures. See Pathogen specific therapy for intravascular catheter related infections
- For patients with penicillin allergy label consider penicillin allergy assessment and delabelling
Where patients are able to be discharged and lines have been removed (where possible), ambulatory treatment can be given:
Preferred:
For MSSA bloodstream infection:
cefazolin given as bolus doses after haemodialysis. Dose interval depends on time between haemodialysis sessions e.g. cefazolin 2g Monday, 2g Wednesday and 3g Friday
AND If line is retained use vancomycin 5mg/mL line lock
For MRSA bloodstream infection:
Oral switch:
Oral treatment may be preferred for some patients. Discuss all cases with Micro/ID who may recommend:
cefalexin 500mg po tds AND if line is retained use vancomycin 5mg/mL line lock
OR
co-trimoxazole 960mg po bd AND if line is retained use vancomycin 5mg/mL line lock
OR
linezolid* 600mg po bd AND if line is retained use vancomycin 5mg/mL line lock
*Linezolid metabolites may accumulate in patients with renal failure. These are not removed by haemodialysis. These metabolites have MAOI activity. Monitor patients closely for adverse effects.