Spectrum: Local Antimicrobial Stewardship, for AHS Calgary Zone

Coagulase negative Staph CRBSI

Catheter removal recommended if line infection suspected.

If line retention desired (ie. sole vascular access, required for life-sustaining therapy) consultation with Infectious Diseases recommended.

Consider contamination in the setting of a single positive blood culture or line tip positivity without a positive blood culture

Repeat blood culture q24-48h until negative

If susceptible, treat with cloxacillin or cefazolin

If isolate identified as S. lugdenensis, treat like S. aureus - discuss with Infectious Diseases

With catheter removal, shorter duration appropriate with this organism (0 - 5 days), unless

patient has intravascular hardware (i.e. pacemaker, prosthetic valve), then longer duration required and must rule out endocarditis - discuss with Infectious Diseases

If catheter retention desired,

fever and bacteremia MUST resolve within 72h AND patient must not have intravascular hardware, signs of IE or local signs of inflammation

Can consider Antimicrobial Lock Therapy

Antimicrobial lock therapy involves instilling a high concentration of an antibiotic or other chemical (i.e. 70% ethyl alcohol) into the catheter lumen and letting it dwell.  Consultation with Infectious Diseases is recommended as no formal protocol exists in Calgary.