Bacterial Endocarditis

Consult a Cardiologist immediately and liaise with the on-call Microbiologist. Ensure 3 sets of blood cultures are obtained PRIOR to initiation of antibiotic therapy and that adequate volumes are obtained.

If the disease is slowly progressing and the patient is stable, consider delaying antimicrobial therapy pending blood culture results.

For children with structural heart defects who are at risk of endocarditis who present with fever should have 2 sets of blood cultures prior to antimicrobial therapy irrespective of focus of infection.

Central Line Infection

It is important to obtain blood cultures through both the vascular catheter and peripheral venepuncture.

Intravascular catheter-related sepsis

Teicoplanin IV

Plus

Gentamicin IV

Duration: 10 days from line removal

Teicoplanin is preferred to vancomycin because these patients frequently have single lumen vascular catheters and are often on TPN.

Discuss with the specialty service responsible for the line

Non-tunnelled central venous catheters and arterial cannulae
Vancomycin IV

Duration: 10 days from line removal

Discuss with Microbiology