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Antimicrobials
Initiate therapy with and continue vancomycin (high target trough level) until susceptibilities available.
Vancomycin (High Target Trough Dose)
If known to be colonized by VRE consider linezolid or daptomycin and consult ID.
If E. faecalis, use Ampicillin 2g IV q4-6h empirically
If E. faecium, continue vancomycin.
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.
Duration of therapy for uncomplicated disease 7 days.
Catheter removal recommended. If retention necessary, consider Antimicrobial Lock Therapy.
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 or an Antimicrobial Stewardship pharmacist is recommended.
