Intravascular catheter infections

L53.9/T80.2 + (B95.8/Y84.8/B37.8)

PERIPHERAL LINE INFECTION:

Common organisms:

  • coagulase negative staphylococci, particularly S. epidermis
  • S. aureus

The intravascular line should always be removed.

Microbiologic specimens: peripheral blood culture, blood culture from central catheter prior to removal, and culture of the catheter tip.

Small localised area of erythema at the catheter insertion site will usually resolve without antibiotic therapy.

In patients with larger areas of erythema and tenderness extending beyond the insertion site who are systemically well:

  • Clindamycin, oral, 450 mg 8 hourly for 5 days.

LoEIII [1]

If patients with peripheral or central venous catheter infections are systemically unwell they should be treated as a venous catheter related systemic blood infection.

MEDICINE TREATMENT

Empiric antibiotic therapy

Duration of antibiotic therapy should generally be for 48–72 hours after resolution of fever except for:

  • confirmed S. aureus infection, and

LoEIII [2]

  • candidaemia, where treatment should be continued for 2 weeks after the 1st negative blood culture.

LoEIII [3]

NOTE

For candidaemia and S. aureus infection, perform blood cultures every 2-3 days after therapy has been initiated until 2 consecutive cultures are negative, and 2 weeks after the 1st negative blood culture.

S. aureus infection

(B95.8/Y84.8)

  • Vancomycin, IV, 30 mg/kg, empirically as a loading dose.
    • Follow with 20 mg/kg/dose 12 hourly.
    • Tailor therapy to drug-susceptibility results.

  • (See VANCOMYCIN, IV for prevention, monitoring and management of toxicity).

LoEIII [4]

Candidaemia

(B37.8/Y84.8)

NOTE

Candida isolated from blood culture should always be treated, even if the fever has settled after line removal because of a high risk of late complications.

Candidaemia with species other than Candida albicans is becoming increasingly common – these species are often resistant to azoles.

Treatment duration should be 2 weeks after 1st negative blood culture :

  • Amphotericin B, IV, 0.7 mg/kg daily.

LoEIII [5]

  • Ensure adequate hydration to minimise nephrotoxicity.

LoEI [6]

Follow up susceptibility:

Once improved, complete course with:

  • Fluconazole, oral, 800 mg daily.

LoEIII [7]

Intolerance to amphotericin B :

  • Fluconazole, oral, 800 mg daily
    • Dose adjust in renal impairment.

Invasive candidiasis (resistant to fluconazole/amphotericin B or renal impairment is present and amphotericin B cannot be used):

  • Echinocandins. (Specialist motivation).

REFERRAL/CONSULTATION

S. aureus endocarditis.