Patients who present with clinical sepsis in the presence of a hemodialysis line or a central line.
Antimicrobial
Vancomycin 25-30mg/kg IV loading dose
For patients on haemodialysis give further doses after haemodialysis (usually 3 times a week). For subsequent dosing in all patients see Vancomycin dosing section.
PLUS
Gentamicin 4-5mg/kg IV OD
Single dose only for dialysis patients.
If patient is in septic shock replace Gentamicin with:
Amikacin 28mg/kg IV as a first dose in patients with creatinine clearance >60ml/minute. Use 16-20mg/kg if creatinine clearance <60ml/minute.
Single dose only for dialysis patients. For subsequent doses see Aminoglycoside dosing section.
Child 15mg/kg IV OD.
If amikacin is not available and patient is likely to have normal renal function give above regime but increase Gentamicin to 7mg/kg IV for first dose.
Alternative:
If vancomycin is not available use:
Cloxacillin 2g IV QID
Comments and Duration of Therapy
Take blood cultures from line and peripherally before antibiotics. If line is removed send tip for culture.
Change antibiotics according to culture and susceptibility results.
Where possible remove line.
Duration:
If there is rapid clinical improvement after removal of line treat for 5-7 days.
Infections with Staphylococcus aureus and Candida spp. require longer durations see Staphylococcus aureus bacteraemia in Chapter 12: Sepsis and Directed Therapy for Blood Stream Infections, and Candidaemia in Chapter 12: Sepsis and Directed Therapy for Blood Stream Infections.