Empirical management of intravascular catheter related 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 Ambulatory management of haemodialysis lines with Staphylococcus aureus Bloodstream infection see HERE
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For patients with penicillin allergy label consider penicillin allergy assessment and delabelling
Peripheral vascular catheter infection - Non-severe
Non-severe infections may be characterised as those with localised erythema and pain only, with no signs of systemic infection.
Treat for 5 days.
Preferred: flucloxacillin 500mg po qds
For penicillin allergy (non-severe and severe) OR for MRSA positive patients: doxycycline 100mg po bd
Central vascular catheter infection or Severe peripheral vascular catheter infection
- Includes peripheral cannula, PICC, central intravascular catheter (tunnelled or not), haemodialysis catheters (temporary, permanent and tunnelled)
- Severe infections include those with evidence of systemic infection or sepsis or a positive blood culture.
- Removal of infected vascular catheters is a priority where possible
- If blood cultures are positive, see Pathogen specific therapy for intravascular catheter related infections
- For neutropenic patient: See Neutropenic sepsis guideline
Preferred (includes MRSA positive patients):
teicoplanin iv AND flucloxacillin 2g iv qds AND if line is retained use vancomycin 5mg/mL line lock
If severe sepsis or septic shock or immunocompromised patient: ADD gentamicin 5mg/kg iv (gentamicin is for maximum of 3 days). Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.
- Review with results at 24 hours and discuss with Micro/ID.
Alternative (includes MRSA positive patients):
For penicillin allergy (non-severe):
teicoplanin iv AND cefazolin 2g iv tds AND if line is retained use vancomycin 5mg/mL line lock
If severe sepsis or septic shock or immunocompromised patient: ADD gentamicin 5mg/kg iv (gentamicin is for maximum of 3 days). Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.
- Review with results at 24 hours and discuss with Micro/ID.
For penicillin allergy (severe) (includes MRSA positive patients):
teicoplanin iv AND if line is retained use vancomycin 5mg/mL line lock
If severe sepsis or septic shock or immunocompromised patient: ADD gentamicin 5mg/kg iv (gentamicin is for maximum of 3 days). Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.
- Review with results at 24 hours and discuss with Micro/ID.
Oral switch:
Oral treatment may be preferred for some patients. Discuss all cases with Micro/ID who may recommend:
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
OR
cefalexin 1g po tds AND if line is retained use vancomycin 5mg/mL line lock
Ambulatory management of OPAT patients not receiving haemodialysis
teicoplanin iv AND if line is retained use vancomycin 5mg/mL line lock
Oral switch:
Oral treatment may be preferred for some patients. Discuss all cases with Micro/ID who may recommend:
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
OR
cefalexin 1g po tds AND if line is retained use vancomycin 5mg/mL line lock
Tunnelled Central Intravascular Catheter - uncomplicated exit site infection ONLY
- Includes tunnelled central intravascular catheter (e.g. Hickman®), tunnelled haemodialysis catheters (e.g. Tesio®)
- Blood cultures (central and peripheral) are NEGATIVE
- For cases where sepsis or severe sepsis is evident refer to guideline Central intravascular catheter - systemic sepsis (above)
Treat for 5 days.
Preferred: flucloxacillin 500mg po qds (IV for severe cases)
For penicillin allergy (non-severe and severe) OR MRSA positive patients: doxycycline 100mg po bd