Table 4.

Empirical antimicrobial treatment in CLABSI

Scenario	Antibiotic of choice
Gram-positive coverage
Usual gram-positive coverage with anti-staphylococcal cover in MSSA	Cloxacillin or cefazolin
MRSA prevalence	Vancomycin
MRSA with MIC > 2 mg/mL for vancomycin or vancomycin-resistant enterococci	Daptomycin
Gram-negative coverage
Gram-negative coverage	3rd generation cephalosporins (ceftriaxone)
High risk for resistant organisms	β-lactam & β-lactamase inhibitor or combination of 4th generation cephalosporins or carbapenem with or without aminoglycoside
Neutropenia with immunosuppression Cystic fibrosis with prior colonization	Anti-pseudomonal coverage required
Candida suspicion
Candida suspected	Echinocandin or fluconazole initial choice
Azole resistance or non-Candida albicans (C. glabrata or C. krusei)	Echinocandins (micafungin, caspofungin, anidulafungin)
Duration of therapy
Complicated CLABSI - endocarditis or suppurative thrombosis or metastatic infection	4–6 wk
Uncomplicated CLABSI	Staphylococcus aureus -14 d CONS -7 d Enterococci and gram-negative bacilli -10–14 d Candida -14 d from last sterile culture

CLABSI Central line–associated blood stream infection, CONS Coagulase-negative staphylococcus, MIC Minimum inhibitory concentration, MRSA Methicillin-resistant Staphylococcus aureus, MSSA Methicillin-sensitive Staphylococcus aureus