Renal Unit. Catheter Related Bacteraemia Guidelines

Transcription

1 Renal Unit Policy Manager Drew Henderson Policy Group Renal Unit Policy Established 21/01/2014 Policy Review Period/Expiry 21/01/2015 Last Updated 21/01/2014 This policy does apply to Medical/Dental Staff UNCONTROLLED WHEN PRINTED

2 Policy Development, Review and Control Policy Version Control Version Number Purpose/Change Author Date 1.0 Initial Draft Policy Drew Henderson 21/01/ Post AMG discussion Drew Henderson 17/02/2014 Change of duration of Flucloxacillin for MSSA 1.2 Review following IC discussion Drew Henderson 14/03/2014 Changes to document but no major changes in therapy 1.3 Finalised Document for publication Drew Henderson 15/04/2014

3 1. Purpose and Scope The purpose of this document is to standardise the treatment of catheter related bacteraemia in the renal service. Catheter related bacteraemia (CRB) is associated with increased mortality and morbidity in dialysis patients and it is important that treatment as far as possible is standardised to ensure the maximal chance of clearance of infection and reduce morbidity due to distant infection such as osteomyelitis and endocarditis. These guidelines are based on the IDSA guidelines for treatment of catheter related bacteraemia, a recent review in Kidney International, HIS SAB guidelines and are tailored to local antibiotic guidelines. They have been reviewed by NHS Tayside Anti Microbial Group. This guideline acts as guidance and is not rigid and there may be individuals where there requires deviation from standard care (eg last potential access for HD) and in these cases it should documented in the case note why there has been deviation from standard care. This guideline will be referred to when CRBs are reviewed and adherence to the guideline will be audited as part of the Renal Unit s ongoing review of bacteraemias. 2. Abreviations CRB C+S CVC CNS MSSA MRSA TTE TOE CEX BC Catheter related Bacteraemia Culture and Sensitivities Central Venous Catheter Coagulase Negative Staphylococci Methicillin Sensitive Staphylococcus aureus Methicillin Resistant Staphylococcus aureus Trans Thoracic Echocardiogram Transoesphageal Echocardiogram Catheter Exchange Blood Cultures

4 EMPIRIC THERAPY Severe Sepsis Start Sepsis 6 D/W On Call Renal Consultant SEVERE SEPSIS MAP<65mmHG or SBP 40mmHG below normal Lactate>4 New Confusion New Oxgen Requirement New Coagulopathy/ Thrombocytopaenia CLINICAL REVIEW SUSPECTED CRB Fever No Other Source CVC in situ Admit to ward 22 Severe Sepsis? Exit Site Infection Blood Cultures (Central and Peripheral) Temporary Line: Exit Site Infection: (DW On Call Nephrologist first) GIVE Vancomycin IV Dose determined by renal unit protocol If concerns re Grm-ve Gentamicin as per renal unit protocol 48 hour Review Remains Febrile if still in situ Review C+S Afebrile Review C+S as available EXIT SITE ASSESMENT Pus at exit site = Definite Infection 2 of Redness, Tenderness, Swelling = Probable Exit site infection

5 Staph Vanc MIC>2 d/w Microbiology Staph aureus Coagulase Negative Staphylococci Remove Line Catheter Exchange MSSA Flucloxacillin 1g qds MRSA or Penicillin Allergic Vancomycin as per renal unit protocol 2/52 Vancomycin as per protocol Repeat blood cultures at hours TTE +ve TOE: Prosthetic Valve IntraVasc Device +ve repeat BC -ve -ve +ve 2/52 IV Therapy 4-6 weeks IV therapy Refer to local endocarditis guidance Blood Culture Review (including sensitivities and MIC for Staph Sp) Culture Negative No other source Enterococci Catheter Exchange Repeat BC 2/52 Vancomycin as per protocol Inpatient Outpatient 2/52 Amoxicillin 1g IV tds Penicillin Allergic- Vancomycin as per protocol 2/52 Vancomycin as per renal unit protocol Refer to ID/Micro Gram Negative (CEX if difficult access) 14/7 Antibiotics guided by C+S and microbiology Fungal Remove Line Antifungal as directed by Microbiology Blood cultures daily TTE 14/7 antifungal post 1 st sterile culture

6 3. References Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America CID 2009:49 Prevention and management of catheter-related infection in hemodialysis patients Kidney International (2011) 79, Renal Unit Vancomycin Protocol atestreleased&nosaveas=1 HIS Guidance on management of proven or suspected Staphylococcus aureus bacteraemia in adults