CARDIOVASCULAR Ongoing management / MINIMUM INFECTION Most likely causal organisms First choice duration of antibiotic therapy Strep. viridans Benzylpenicillin IV and gentamicin IV (gentamicin as per Duration depends on organism. Discuss with Staph. aureus endocarditis dosing regimen 2.5mg/kg 8 hourly if >1 month infection team. – Enterococci of age). Stop gentamicin after 7 days. Coagulase negative staphylococcus If suspected Staph. aureus or septic shock, flucloxacillin IV and gentamicin IV (gentamicin as per endocarditis dosing Send minimum 3 blood cultures prior to regimen 2.5mg/kg 8 hourly if >1 month of age) – commencing antibiotics If prosthetic material in situ, likely coagulase negative Infective For persistent positive blood culture despite staphylococci or MRSA, or penicillin allergy, use appropriate antibiotics, discuss with endocarditis vancomycin IV, rifampicin (IV initially) and gentamicin IV. microbiology/ID team. Staph. aureus Neck cannulation without open chest: stat dose of Monitor renal function and antibiotic levels. Coagulase negative staphylococcus vancomycin IV and gentamicin IV at the time of cannulation Gram negative organisms including E and decannulation. coli, Klebsiella and Pseudomonas Open chest cannulation: vancomycin IV and gentamicin spp. IV for 48 72 hrs (depending on ongoing need for recurrent – chest re-exploration). Further stat dose of vancomycin IV Children on ECMO and gentamicin IV prior to decannulation if off Abs. Deterioration on ECMO: vancomycin IV, gentamicin IV and piperacillin/tazobactam IV.
CARDIOVASCULAR INFECTION Most likely causal organisms First choice Ongoing management / MINIMUM duration of antibiotic therapy Infective endocarditis Strep. viridans Staph. aureus Enterococci Coagulase negative staphylococcus Benzylpenicillin IV and gentamicin IV (gentamicin as per endocarditis dosing regimen – 2.5mg/kg 8 hourly if >1 month of age). If suspected Staph. aureus or septic shock, flucloxacillin IV and gentamicin IV (gentamicin as per endocarditis dosing regimen – 2.5mg/kg 8 hourly if >1 month of age) If prosthetic material in situ, likely coagulase negative staphylococci or MRSA, or penicillin allergy, use vancomycin IV, rifampicin (IV initially) and gentamicin IV. Duration depends on organism. Discuss with infection team. Stop gentamicin after 7 days. Send minimum 3 blood cultures prior to commencing antibiotics For persistent positive blood culture despite appropriate antibiotics, discuss with microbiology/ID team. Children on ECMO Staph. aureus Coagulase negative staphylococcus Gram negative organisms including E coli, Klebsiella and Pseudomonas spp. Neck cannulation without open chest: stat dose of vancomycin IV and gentamicin IV at the time of cannulation and decannulation. Open chest cannulation: vancomycin IV and gentamicin IV for 48 – 72 hrs (depending on ongoing need for recurrent chest re-exploration). Further stat dose of vancomycin IV and gentamicin IV prior to decannulation if off Abs. Deterioration on ECMO: vancomycin IV, gentamicin IV and piperacillin/tazobactam IV. Monitor renal function and antibiotic levels.
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