Empirical management of intravascular catheter related infections
Includes: peripheral intravascular cannula, PICC, central intravascular catheter, pacemakers, implanted defibrillator
- Device removal is a priority, when 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
- CVC removal is not mandatory when bacteria are cultured from a line but Pseudomonas aeuroginosa and Staphylococcus aureus have been harder to clear in some studies. Most authorities would recommend removal of a line infected with Candida species. Discuss with Paediatric ID.
- Take blood cultures from intravascular line ideally prior to treatment.
- Therapy should be tailored to microbiology results from cultures.
- Consult Paediatric ID
- If patient febrile neutropenic refer to febrile neutropenia guidelines
Peripheral vascular catheter infection (cannulae) - non severe
Always remove infected peripheral cannulae.
Treat for 3-5 days.
Preferred
flucloxacillin po (see dosing table)
|
Age |
flucloxacillin oral dose |
|
1 month to 1 year |
62.5mg-125mg QDS |
|
2-9 years |
125mg-250mg QDS |
|
10-17 years |
250mg-500mg QDS |
cefalexin 25mg/kg (Max 1g) po TDS
For penicillin allergy (severe)
clarithromycin po (see dosing table)
|
Weight |
clarithromycin oral dose |
|
under 8 kg |
7.5mg/kg BD |
|
8-11 kg |
62.5mg BD |
|
12-19kg |
125mg BD |
|
20-29kg |
187.5mg BD |
|
30-40kg |
250mg BD |
|
12-17 years |
250mg BD |
Peripheral vascular catheter infection (cannulae) - severe
Always remove infected peripheral cannulae.
Review with results at 24 hours and discuss with Paediatric ID.
Preferred
flucloxacillin 50mg/kg (Max 2g) iv QDS
If septic shock ADD gentamicin 7mg/kg (Max 560mg) iv single dose
If severe penicillin allergy or MRSA positive
teicoplanin iv
If septic shock ADD gentamicin 7mg/kg (Max 560mg) iv single dose
Central intravascular catheter - systemic sepsis
Includes PICC, central intravascular catheter (tunnelled or not), haemodialysis catheters (temporary and permanent, (tunnelled or not)).
Review with results at 24 hours and discuss with Paediatric ID
Preferred (inc MRSA patients)
ceftriaxone 80mg/kg (Max 4g) iv OD AND teicoplanin iv
If severe penicillin allergy
teicoplanin iv
AND
ciprofloxacin* 10mg/kg (Max 400mg) iv TDS OR ciprofloxacin* 20mg/kg (Max 750 mg) po BD
*ciprofloxacin may induce convulsions in patients with or without a history of convulsions – use with caution
Tunnelled Central Intravascular Catheter - exit site infection ONLY
Includes tunnelled central intravascular catheter (e.g. Hickman®), tunnelled haemodialysis catheters (e.g. Tesio®)
For cases with sepsis or high-risk patient (e.g. under 3 months old, immunosuppressed) refer to guideline Central intravascular catheter - systemic sepsis (above)
Treat for 7 days
Preferred
flucloxacillin po (see dosing table)
|
Age |
flucloxacillin oral dose |
|
1 month to 1 year |
62.5mg-125mg QDS |
|
2-9 years |
125mg-250mg QDS |
|
10-17 years |
250mg-500mg QDS |
For penicillin allergy (non-severe) or if Flucloxacillin not tolerated
cefalexin 25mg/kg (Max 1g) po TDS
For penicillin allergy (severe)
clarithromycin po (see dosing table)
|
Weight |
clarithromycin oral dose |
|
under 8 kg |
7.5mg/kg BD |
|
8-11 kg |
62.5mg BD |
|
12-19kg |
125mg BD |
|
20-29kg |
187.5mg BD |
|
30-40kg |
250mg BD |
|
12-17 years |
250mg BD |