Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

CNST

Note

If a catheterized patient has a single positive blood culture that grows coagulase-negative Staphylococcus species, then additional blood cultures obtained through the suspected catheter and from a peripheral vein should be performed before the initiation of antimicrobial therapy and/or catheter removal to be certain that the patient has true bloodstream infection and that the catheter is the likely source.

Coagulase-negative staphylococcal Bacteremia can be divided into 3 categories:

Simple

  • Single blood culture positive for coagulase-negative staphylococci

  • Negative follow-up blood culture

  • No signs or symptoms of local infection at a catheter site

  • No symptoms or signs of metastatic infection

  • No indwelling intravascular prosthetic devices

Uncomplicated

  • 2 or more blood cultures positive for coagulase-negative staphylococci drawn 24 hours or more apart, OR

  • Single blood culture positive for coagulase-negative staphylococci, PLUS symptoms or signs of infection at a catheter site

Complicated

  • 2 or more blood culture positive for coagulase negative staphylococci from samples drawn over 24 hours apart, OR

  • Echocardiography with evidence of endocarditis, OR

  • Symptoms or signs of metastatic infection