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Pathogens
Antimicrobials
Catheter removal recommended; if retention necessary, discuss with Infectious Diseases
Continue vancomycin until susceptibilities available. Once susceptibilities available, narrow therapy to ampicillin if susceptible
Evaluate for features of endocarditis (persistent bacteremia, prosthetic valve, murmur or embolic finding) and obtain echocardiography if suspicious
IF VRE colonized, consider linezolid or daptomycin pending susceptibilities
Linezolid 600mg PO/IV q12h Daptomycin 6-10mg/kg IV daily
If E. faecalis, can use Ampicillin 2g IV q4-6h empirically based on 100% susceptibility in Calgary
If E. faecium, use: Linezolid or Daptomycin empirically as 1/3 are VRE in Calgary
Duration of therapy for uncomplicated disease 7-14 days
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.
