Empirical therapy for suspected bloodstream infection associated with an intravenous catheter
For patients with suspected bloodstream infection associated with an intravenous catheter who have sepsis or septic shock, obtain blood samples (from each catheter lumen and peripherally) for culture, and send the catheter tip for culture following removal. Start antibiotic therapy within 1 hour of presentation to medical care or, for ward-based patients, development of sepsis or septic shock. Antibiotics should be administered immediately after blood samples are taken for culture. For nonantibiotic management of sepsis or septic shock, see Resuscitation of patients with sepsis or septic shock.
For adults and children with febrile neutropenia and intravenous catheter infection, treat as for febrile neutropenia.
For adults and children without febrile neutropenia who have a suspected bloodstream infection associated with an intravenous catheter, use:
vancomycin intravenously; for initial dosing, see Vancomycin dosing in adults or Intermittent vancomycin dosing for young infants and children. Loading doses are recommended for critically ill adults. See advice on modification and duration of therapy. vancomycin vancomycin vancomycin
If there is a high risk of gram-negative infection (eg peripherally inserted central catheter [PICC] lines that are inserted into inguinal veins), add an aminoglycoside to the vancomycin regimen. Administer vancomycin after the aminoglycoside because of the long infusion time required. Add to the vancomycin regimen:
1gentamicin intravenously; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing. See advice on modification and duration of therapy gentamicin gentamicin gentamicin
adult: see Gentamicin initial dose calculator for adults for initial dose
child younger than 18 years: 7 mg/kg up to 560 mg for initial dose12
OR
1tobramycin intravenously; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing. See advice on modification and duration of therapy tobramycin tobramycin tobramycin
adult: see Tobramycin initial dose calculator for adults for initial dose
child younger than 18 years: 7 mg/kg up to 560 mg for initial dose12.