This handout is for catheter-related bloodstream infection (crbsi / clabsi). Your care team identified this based on: positive blood culture in patient with intravascular catheter (mermel idsa 2009).
Other reasons your team may use this plan: central-line blood culture flags positive ≥ 2 h before peripheral (dtp > 2 h; mermel idsa 2009); fever, rigors, or hemodynamic decompensation in patient with line (mermel idsa 2009); semiquantitative maki tip ≥ 15 cfu or quantitative ≥ 10² cfu at line removal (mermel idsa 2009).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| vancomycin | 25-30 mg/kg IV load × 1 → 15-20 mg/kg IV q8-12 h targeting AUC24 400-600 mg·h/L | IV | q8-12h (AUC-titrated) | Mermel IDSA 2009 + Rybak ASHP/IDSA 2020 — covers MRSA + CoNS + most Enterococcus; AUC-targeted dosing is the 2026 standard (PMID 32191793) |
| cefepime | 2 g IV q8h (extended infusion 3-4 h preferred in shock) | IV | q8h | Mermel IDSA 2009 — anti-pseudomonal cover; most common empiric GNR partner; renal adjust for CrCl < 60 |
| piperacillin_tazobactam | 4.5 g IV q6h (extended infusion 4 h preferred) | IV | q6h | Mermel IDSA 2009 — alternative GNR + anti-pseudomonal + anaerobic cover; useful when concurrent intra-abdominal source |
| meropenem | 1 g IV q8h (2 g q8h CNS / severe) | IV | q8h | Mermel IDSA 2009 — reserve for ESBL risk, septic shock, or local antibiogram resistance pattern; spare to minimise emergence |
| caspofungin | 70 mg IV load × 1 → 50 mg IV daily | IV | daily | Pappas IDSA 2016 — empiric echinocandin when Candida-risk factors present pending blood-culture speciation; routes to id.candidemia.core.v1 if Candida confirmed |
| micafungin | 100 mg IV daily | IV | daily | Pappas IDSA 2016 — alternative echinocandin; equivalent efficacy to caspofungin |
| anidulafungin | 200 mg IV load × 1 → 100 mg IV daily | IV | daily | Pappas IDSA 2016 — alternative echinocandin; no renal or hepatic dose adjustment |
| daptomycin | 8-10 mg/kg IV daily (12 mg/kg for VRE bacteremia per IDSA VRE 2014) | IV | daily (q48h if CrCl < 30) | Mermel IDSA 2009 + IDSA VRE 2014 — high-dose for bacteremia/IE; weekly CK monitoring per DailyMed daptomycin label; NOT for pneumonia (surfactant inactivation) |
Plan: CRBSI empiric — vancomycin AUC + GNR cover ± echinocandin until pathogen known (Mermel IDSA 2009)
Call 911 or go to the nearest emergency room right away if you have:
OPAT enrollment for prolonged-duration regimens; ID outpatient follow-up; re-line decision; prevention review (CHG bathing, daily-necessity assessment, full-barrier insertion); patient education on line care (Mermel IDSA 2009; CDC/HICPAC BSI Prevention; Norris IDSA OPAT 2018)
Guideline: Mermel IDSA CRBSI 2009 (Mermel et al, CID 2009 PMID 19489710) — canonical guideline; still operative in 2026. Supplemented by CDC/HICPAC BSI Prevention (O'Grady), ASHP/IDSA Vancomycin AUC Consensus 2020 (Rybak PMID 32191793), IDSA Candidiasis 2016 (Pappas PMID 26679628), AHA Endocarditis 2015 (Baddour PMID 26373316).