For overall management of renal (dialysis) vascular access device infection, including sampling, please refer to the relevant renal department guideline.
Consider early line removal for any non-tunneled lines, e.g. PICC.
Consider line removal if salvage is attempted, but pyrexia continues after >72 hours of appropriate antimicrobial therapy or the patient deteriorates with new onset septic shock.
Duration of treatment depends on presence or absence of systemic bacteraemia, the causative organism and whether (and when) the device is removed or salvage is attempted.
Line removal is strongly recommended for proven line infection with S. aureus, P. aeruginosa or Candida species.
See below for sampling of suspected vascular access device infections:
|
|
Pillar 1: S. aureus |
Pillar 2: Gram negative organisms, including P. aeruginosa |
|
Superficial exit site infection No penicillin allergy No MRSA
|
Flucloxacillin oral 500mg 6 hourly |
Not routinely required |
|
Superficial exit site infection Penicillin allergy or known MRSA
|
Doxycycline oral 200mg as a single dose, then 100mg 12 hourly |
Not routinely required |
|
|
Pillar 1: Staphylococci, including MRSA, streptococci, and enterococci |
Pillar 2: Gram negative organisms, including P. aeruginosa |
|
Suspected infection of vascular access device (“line”), the line tunnel or arterio-venous fistula (AVF)
|
Vancomycin IV* (dosing info here) |
Gentamicin IV* (dosing info here) |
*use renal dosing guidelines for patients receiving haemodialysis
Specific individuals may require additional empirical antifungal cover if they present with a suspected line infection and evidence of severe sepsis. These individuals include the following:
For high risk patients presenting with severe sepsis add Fluconazole IV 800mg as a stat dose and continue at 400mg once daily thereafter to the above regimen.
| Guideline reviewed | December 2023 |
| Page updated | March 2024 |