Central Catheter-related Bloodstream Infection

If antibiotics are required

Therapy

As most line infections are due to coagulase-negative staphylococci, initial therapy should be directed against these organisms.

Vancomycin (Dosing as per guideline. Use Vancomycin calculator )

or

Teicoplanin 

6mg/kg 12 hourly for 3 doses then 6mg/kg  24 hourly

Review Daily (Check dose with Microbiologist as in some cases higher doses required).

Add gentamicin if systemically unwell

(extended interval dosing as per guideline. Use gentamicin calculator )

Antibiotics should be reviewed after 48 hours when cultures results are available and if necessary de-escalated. They may no longer be required after removal of the line, or could be changed to match the sensitivities of any organisms detected. Clinical judgment and discussion with Consultant Microbiologist is required.

Notes

The priority is prevention of infection from these lines.  Adhere rigidly to the care bundles for these lines.  Review the need for the line daily and if not required remove it. The rate of

infection from these lines has been significantly reduced by following these rules and very careful insertion in the first place.

If infection from a central line is suspected (Catheter Related Blood Stream Infection) the default position should be to remove the line. For tunnelled lines (Hickman lines) this is difficult, so discuss with a Consultant.

The tip of the removed central line should be sent for culture along with peripheral blood cultures. For removal of central lines, advice and guidelines are available from ITU.