Antibiotic Lock Solution Guideline - UW Health
Antibiotic Lock Solution Guideline - UW Health
Antibiotic Lock Solution Guideline - UW Health
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4.2.1.4.2 Table 4: Salvage regimens with anti-infective lock(ALT) if decision to retain tunneled CVC/IVD.Infectious Disease approval required for non-HDcatheter ALT. Nephrology or Infectious Diseaseapproval required for HD catheter ALT.OrganismS aureusCoagulasenegativeStaphylococcusGram- negativebacilliCandida sppDecision to removeCV or IVD?Yes-remove CVC/IVDand treat with systemicanti-infective perInfectious DiseaserecommendationMay retain-see salvagetherapyIf yes-remove CVC/IVDand treat with systemicanti-infectives perInfectious DiseaserecommendationYes-remove CVC/IVDand treat with systemicantifungals perInfectious DiseaseDecision toretainCVC/IVD?No-lowsuccess rateYes – usesalvagetherapyIf yes – usesalvagetherapyNo-lowsuccess rateSalvageregimenSystemictreatment plusALT(antiinfectivesandduration perInfectiousDisease)Systemictreatment plusALT(antiinfectivesandduration perInfectiousDisease)Salvageregimen failure?RemoveCVC/IVD ifpersistent orrelapsingbacteremia orclinicaldeteriorationIf no response,remove CVC/IVDand treat withsystemic antiinfectivesperInfectiousDisease4.3 ALT Treatment Regimens by Organism4.3.1Candida: salvage is almost never justified due to high risk of endocarditis orother metastatic complicationso Ethanol 50% in silicone catheters only . Note: not compatible with heparin –see section 5.0o Hemodialysis – remove catheter4.3.2 Staphylococcus aureus ( MRSA) salvage is almost never justified due tohigh risk of endocarditis or other metastatic complicationsooEthanol 50% in silicone catheters only. Note: not compatible with heparin – seesection 5.0.Hemodialysis – remove catheter