A. Evaluation
Detailed history and physical examination
Bacterial cultures
a. Obtain blood cultures from a venipuncture site and, for
patients with a central venous catheter, from each port
of the catheter.
b. Obtain cultures of urine and other potential sites of
infection as indicated by history and physical examination (e.g., aspiration of cellulitis site or cerebrospinal
fluid if meningitis is suspected).
3. Radiographs as indicated by history and physical examination
B. Therapeutic measures
1. When a central venous catheter is not present
a. If a specific infection is not documented, continue to
examine daily and monitor clinically with daily blood
cultures and other relevant laboratory studies, but do
not start antibiotics.
b. If a specific pathogen is isolated, treat with specific
antibiotics.
2. When a central venous catheter is present
a. If only an exit-site infection is suspected, obtain blood cultures from all ports of the catheter, one venipuncture site (if practical), and the exit site.
i. Begin antibiotic therapy with dicloxacillin 25
mg/kg/day PO divided q6h.
ii. Re-examine at 24-48 hours.
iii. If improved, finish 10-day course of antibiotic
therapy.
iv. If not improved after 48 hours of dicloxacillin, commence therapy with vancomycin 40 mg/kg/day IV
divided q8h (maximum 2 g/day) and tobramycin or
gentamicin 6-7.5 mg/kg/day IV divided q8h.
v. If not improved after 72 hours of parenteral therapy,
change antibiotics or consider removing the
catheter.
b. If there is no evidence of local infection, obtain blood
cultures from all catheter ports and one venipuncture site. Many physicians would choose to commence parenteral therapy with ceftriaxone 50 mg/kg IV q24h.
c. If the cultures are negative and the fever defervesces,
stop antibiotic therapy after 48 hours.
d. If the cultures are positive, adjust antibiotic therapy
appropriately to sensitivity of the organisms. If cultures remain positive despite 48 hours of appropriate
antibiotic therapy, strongly consider removing the central venous line.
e. If the cultures become negative, complete a 10- to 14-
day course of antibiotics and do not remove the
catheter.
*16\168\2*
Cancer
