• For all gram negative infection in patients on short-term catheters, catheter removal is essential.
• When CLABSI due to gram negative bacilli is suspected, initial empiric coverage with antibiotics belonging to two different classes is recommended when MDR organisms are prevalent, which may be de-escalated to a single appropriate antibiotic, once culture and susceptibility results are available.
• Antibiotic lock therapy may be used if catheter salvage is essential, but only in combination with systemic antimicrobial therapy. Response to therapy should be closely monitored and line removal considered if there is persistent bacteraemia.
• Duration of antimicrobial therapy is usually 7-14 days. In patients with gram-negative bacillary CLABSI involving a long-term catheter and persistent bacteraemia or severesepsis despite systemic and antibiotic lock therapy, the deviceshould be removed, an evaluation for endovascular infectionand metastatic infection should be pursued, and the durationof antibiotic therapy should be extended beyond 7–14 days.

CLABSI due to Gram positive cocci and suggested antibiotics

Etiology	Suggested regimens		Remarks
	Preferred	Alternative
E. coli Carbapenem sensitive	Imipenem/cilastatin IV 500 mg q6h Or Meropenem IV 1g q8h	Cefoperazone Sulbactam(2:l) IV 3 g q12 h Or Piperacillin-tazobactam IV 4.5g q6h	Third generation cephalosporins may be used in E. coli/Klebsiella infections if the organism is susceptible When using fosfomycin for patients with estimated creatinine clearances of 40, 30, 20, and 10 ml/min, a reduction to 70%, 60%, 40%, and 20% of the daily recommended dose, respectively, is proposed. In patients undergoing intermittent dialysis (every 48 h), 2 g after each session is recommended (Falagas CMR 2016)
			High dose imipenem may be combined with colistin when imipenem MICs are favourable. Meropenem is superior to Piperacillin- tazobactam while treating ceftriaxone resistant, carbapenemsensitiveE.coli/ Klebsiella infections.
Klebsiella spp Carbapenem sensitive	Imipenem/cilastatin IV 500 mg q6h Or Meropenem IV 1g q8h	Cefoperazone Sulbactam(2:l) IV 3 g q12 h Or Piperacillin-tazobactam IV 4.5g q6h
			Combinations of susceptible agents should be used with carbapenem, colistin resistant Enterobacteriaceae
Acinetobacter spp Carbapenem sensitive	Meropenem IV 1g q8h	Piperacillin-tazobactam IV 4.5g q6h
Pseudomonas spp Carbapenem sensitive	Meropenem IV 1g q8h Or Piperacillin-tazobactam IV 4.5g q6h	Ceftazidime 2 g IV q8h Or Cefepime 2 g IV q8h
Enterobacter/ Citrobacter/ Proteus/ Serratia	Imipenem/cilastatin IV 500 mg q6h Or Meropenem IV 1g q8h
Burkholderia cepacia complex	Meropenem IV 1g q8h	Ceftazidime 2 g IV q8h or Minocycline 200 mg loading dose and 100mg q12h
Stenotrophomonas maltophilia	Minocycline 200 mg stat and 100mg q12h	Trimethoprim-sulfamethoxazole 3–5 mg/kg IV q8h

For Carbapenem resistant organisms; refer to guidelines of CRO