Exit site infections in central lines

• Signs:
  • Pain around exit site            
  • Purulent discharge
  • Erythema / Induration around exit site
• Take samples:
  • Blood culture through the line
  • Peripheral blood cultures
  • Swab of exit site

For temporary central lines

• Remove line
• Vancomycin IV 1g bd (or od if >65 years) (Monitor blood levels; adjust dose if poor renal function or
• if no complicating neutropenia, Doxycycline 100 mg PO BD (1st day) then OD 
• Change to flucloxacillin if methicillin sensitive S.aureus is isolated)

For "permanent" central lines

• Remove line if possible - if blood cultures are positive for S.aureus then line removal is mandatory
• If low MRSA risk:
  • Flucloxacillin 500mg qds for 14 days 
  • If penicillin allergy, Doxycycline 100mg PO BD (1st day) then OD
• If high MRSA risk:
  • Vancomycin IV 1g bd (or od if >65 years) (Monitor blood levels; adjust dose if poor renal function)

Notes

• Guidelines apply to immunocompetent patients only.
• Line-associated bacteraemia due to Staph.aureus should be treated by a minimum of 14 days antibiotic therapy after line removal
• Approximately 50% of Staph.aureus isolates are due to MRSA in this situation
• Central-line associated bacteraemia due to Staph.epidermidis may respond to antibiotics without line removal, but relapse is common

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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