18.4 Central Line-Associated Bloodstream Infection (CLABSI)
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| CLABSI without previous antibiotic exposure and stable | Piperacillin- tazobactam 4.5g iv q6h Or Cefoperazone-sulbactam 3g iv bd + Inj Vancomycin (15 mg/kg IV q8–12h) Or Inj Teicoplanin (400mg IV every 12h for 3 doses followed by 400mg IV q24h) | Meropenem 1g iv q8h Or Imipenem -cilastatin 500 mg IV q6h + Inj Vancomycin 1g iv bd Or Inj Teicoplanin (400mg IV every 12h for 3 doses followed by 400mg IV q24h) | All hospital onset infections; should be managed as per hospital antibiograms; these recommendations are general and especially for places where there is no antibiogram (it is highly recommended to generate antibiograms). Blood culture should be obtained prior to initiation of antibiotic therapy. Paired blood samples, drawn from the catheter and a peripheral vein, should be sent for culture, and the bottles should be appropriately marked to reflect the site from which the samples were obtained. If a blood sample cannot be drawn from a peripheral vein, it is recommended that 2 blood samples should be drawn through different catheter lumens. Catheter removal is advised. Duration of therapy is 7- 10 days (depending on pathogen). |
| CLABSI with recent exposure to carbapenems or BL- BLIs exposure and / or unstable | Meropenem 1g q8h Or Imipenem 1g Stat and 500mg IV q6h + Polymyxin B 15-20 lakhs units IV stat, then 7.5-10 lakhs IV q12h or Colistin 9MU IV stat, then 4.5 MU IV q12h Add candida cover (echinocandins) if local antibiograms suggest incidence of candida in CLABSI | Fosfomycin 4g IV q6h as add-on therapy to those mentioned in 1st column (based on local antibiogram) | All hospital onset infections; should be managed as per hospital antibiograms; these recommendations are general and especially for places where there is no antibiogram (it is highly recommended to generate antibiograms). Target therapy based on susceptibility testing results. Combination of Ceftazidime-avibactam 2.5g IV q8h + Aztreonam 2g IV q8h is discouraged to be used empirically as there is resistance reported to this in E.coli and Pseudomonas spp.; it is intrinsically resistant to Acinetobacter baumannii. Duration of therapy is 7- 10 days (depending on pathogen). |
For common etiological agents of Central Line-Associated Bloodstream Infection (CLABSI), see Annexure B.18.4
Additional Information
When to add empirical CRO cover?
- Haemodynamic instability.
- olonisation with carbapenem resistant gram-negative bacteria.
- Previous infection with carbapenem resistant gram-negative bacteria.
- GNB in blood, sensitivity pending, persistent fever with haemodynamic instability.
References
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