TPN should not be stopped unless the Gram-positives (including MRSA, All children on long term TPN with a presumed line patient is haemodynamically unstable. infection should be discussed with UHS gastro team coagulase-negative Staph and Consultant decision to restart TPN. enterococci) within 24 hours of admission. They should all have an individualized antibiotic plan for initial treatment. Gram-negatives (including Staph aureus, pseudomonas aeruginosa, enterobacteriaceae and Assess previous microbiology results and adjust Candida and atypical mycobacteria are Pseudomonas aeruginosa) empirical antibiotic choice to reflect known resistance. unlikely to be successfully cleared from Anaerobes vancomycin IV CVC low threshold forline removal. – + gentamicin IV once daily Sepsis / bacterial Fungal infections such as Candida Remove line urgently if persisting +- metronidazole IV translocation / in haemodynamic instability despite Line locks are not a substitute for systemic Ab therapy. children on TPN appropriate IVAbs. Consider removal of line if blood cultures remain positive despite 72h Consider adding piperacillin/tazobactam IV if likely of appropriate Abs. pseudomonas infection or severe sepsis. Consider empirical caspofungin if severe sepsis (discuss with paeds ID or micro team). Duration of Ab therapy depends whether line removed / organism isolated to – discuss with microbiology/ID team. For information on line locks, see p15 of Locks should be fully withdrawn before using the line. Gram-negatives (including Ciprofloxacin IV and metronidazole Exacerbation of enterobacteriaceae and Decision to start Abs must be made by gastro consultant- Pseudomonas aeruginosa) inflammatory bowel Abs are usually only considered in children with rectal disease disease or in those in whom surgery is likely. Enterococcus Anaerobes
Sepsis / bacterial translocation / in children on TPN Gram-positives (including MRSA, coagulase-negative Staph and enterococci) Gram-negatives (including enterobacteriaceae and Pseudomonas aeruginosa) Anaerobes Fungal infections such as Candida All children on long term TPN with a presumed line infection should be discussed with UHS gastro team within 24 hours of admission. They should all have an individualized antibiotic plan for initial treatment. Assess previous microbiology results and adjust empirical antibiotic choice to reflect known resistance. vancomycin IV + gentamicin IV once daily +- metronidazole IV Line locks are not a substitute for systemic Ab therapy. Consider adding piperacillin/tazobactam IV if likely pseudomonas infection or severe sepsis. Consider empirical caspofungin if severe sepsis (discuss with paeds ID or micro team). For information on line locks, see p15 of Locks should be fully withdrawn before using the line. TPN should not be stopped unless the patient is haemodynamically unstable. Consultant decision to restart TPN. Staph aureus, pseudomonas aeruginosa, Candida and atypical mycobacteria are unlikely to be successfully cleared from CVC – low threshold forline removal. Remove line urgently if persisting haemodynamic instability despite appropriate IVAbs. Consider removal of line if blood cultures remain positive despite 72h of appropriate Abs. Duration of Ab therapy depends whether line removed / organism isolated – to discuss with microbiology/ID team. Exacerbation of inflammatory bowel disease Gram-negatives (including enterobacteriaceae and Pseudomonas aeruginosa) Enterococcus Anaerobes Ciprofloxacin IV and metronidazole Decision to start Abs must be made by gastro consultant- Abs are usually only considered in children with rectal disease or in those in whom surgery is likely.