Methicillin-resistant (MRCoNS):

Vancomycin 60mg/kg/day IV in 3-4 divided doses (max. 3600mg/day)

Target AUC24 of 400-600 mg*hour/L

Methicillin-sensitive (MSCoNS):

Cefazolin 100mg/kg/day IV in 3 divided doses (max. 6 g/day if no endocarditis) 

Diagnosis needs:

1.   Paired blood cultures drawn from both catheters and peripheral vein.

2.   If blood cultures cannot be drawn from peripheral vein, it is recommended that two or more blood cultures should be drawn through different catheter lumen.

Long term catheters should be removed in patients with CRBSI with:

Severe sepsis, suppurative thrombophlebitis, endocarditis, blood stream infections that continue despite 72 hours of antimicrobial therapy or longer to which the infecting organism is susceptible or infections due to Staphylococcus aureus, Pseudomonas aeruginosa, fungi & mycobacterium.

Attempts at catheter salvage are only recommended in uncomplicated CRBSI or CLABSI caused by bacteria that are neither too virulent nor too difficult to eradicate.

Exact optimal duration of therapy has not been established in children with or without catheter removal. 10-14 days after first negative blood culture is usually recommended.

*For CoNS, need to decide whether isolates from blood culture is coloniser or true pathogen.

Methicillin-resistant (MRSA):

Vancomycin 60mg/kg/day in 3-4 divided doses (max. 3600mg/day)

Target AUC24 of 400-600 mg*hour/L

Methicillin-sensitive (MSSA):

Cefazolin 100mg/kg/day IV in 3 divided doses (max. 6 g/day if no endocarditis) 

Diagnosis needs:

1.   Paired blood cultures drawn from both catheters and peripheral vein.

2.   If blood cultures cannot be drawn from peripheral vein, it is recommended that two or more blood cultures should be drawn through different catheter lumen.

Long term catheters should be removed in patients with CRBSI with:

Severe sepsis, suppurative thrombophlebitis, endocarditis, blood stream infections that continue despite 72 hours of antimicrobial therapy or longer to which the infecting organism is susceptible or infections due to Staphylococcus aureus, Pseudomonas aeruginosa, fungi & mycobacterium.

Attempts at catheter salvage are only recommended in uncomplicated CRBSI or CLABSI caused by bacteria that are neither too virulent nor too difficult to eradicate.

Exact optimal duration of therapy has not been established in children with or without catheter removal. 10-14 days after first negative blood culture is usually recommended.

*For CONS, need to decide whether isolates from blood culture is coloniser or true pathogen.

*Piperacillin/tazobactam:

300mg of piperacillin/kg/day in 3-4 divided doses (max. 16g/day) 

--

*Empiric treatment with piperacillin/ tazobactam covers most of the Gram-negative organisms (Enterobacteriaceae), Gram-positive organisms and pseudomonas; follow through with C&S.

Imipenem 60-100mg/kg/day IV in 4 divided doses (max. 4g/day)

OR

Meropenem 60-120mg/kg/day IV in 3 divided doses (max. 6g/day)

Ertapenem 30mg/kg/day IV in 2 divided doses (max. 1g/day)

--

Ceftazidime 150-200 mg/kg/day in 3 divided doses (max. 6g/day)

OR

Piperacillin/tazobactam:

300mg of piperacillin/kg/day in 3-4 divided doses (max. 16 g/day) 

Cefepime 50mg/kg/dose IV q8h (max. 2g/dose)

Not all pseudomonas is drug resistant. If ceftazidime remains susceptible, please use ceftazidime with/without an anti-pseudomonas aminoglycoside to treat. De-escalation is important to preserve antibiotic for future use. 

Fluconazole 12mg/kg IV q24h (max. 800mg/dose) 

*Caspofungin loading dose 70 mg/m2/dose IV q24hr on Day 1, followed by 50 mg/m2/dose IV q24hr thereafter (max. 70 mg/dose)

OR

Amphotericin B lipid complex 3-5 mg/kg/dose IV q24hr (max. 5mg/kg/dose)

Fungaemia: treatment without catheter removal is associated with low success rate and higher mortality.

*Example of alternative echinocandins that may also be used: 

• Micafungin 2mg/kg q24h (max. 100mg) 

• Anidulafungin 1.5-3mg/kg loading dose (max. 200mg/dose), then 0.75-1.5mg/kg q24h (age >28 days) (max. 100mg/dose) 

MRSA:

Vancomycin 60mg/kg/day in 3-4 divided doses (max. 3600mg/day) 

Target AUC24 of 400-600 mg*hour/L 

MSSA:

Cefazolin 100mg/kg/day IV in 3 divided doses (max. 6g/day) 

Remove catheter and a minimum antibiotic treatment of 3-4 weeks. Surgical resection of involved vein if failed conservative therapy.