Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

CNST

Definitions

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 less 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 more than 24 hours apart, OR

  • Echocardiography with evidence of endocarditis, OR

  • Symptoms or signs of metastatic infection

Uncomplicated

If simple infection with no intravascular or orthopedic hardware, remove catheter and observe. Antibiotics not required

Antibiotic Regimen

Vancomycin 15-20mg/kg IV Q12H

Dose to a target trough level of 15-20µg/mL

OR

Cefazolin 2g IV Q8H

*If sensitive

If S. lugdenensis

Treat same as S. aureus

Staphylococcus aureus Treatment

Catheter Management and Duration of Therapy

Short-Term Catheter

Remove catheter

Long-Term Catheter

May retain catheter if uncomplicated.

Remove catheter if complicated, clinical deterioration, persisting fever or bacteremia.

Duration of Therapy After Catheter Removal

Simple: 0-3 days
Uncomplicated: 5 days
Complicated: 7-28 days