For surveillance purposes, a CLABSI is essentially a bloodstream infection attributed to a catheter that was in place within 48 hours of blood culture
IDSA
Catheter-related bloodstream infection (CRBSI) is defined by the IDSA
Confirmed
Peripheral culture and catheter tip culture both positive for same organism
Peripheral culture and catheter lumen culture both positive for same organism with either
Quantitative cultures showing ≥3-fold higher CFU from the catheter
Time-to-positivity of the catheter culture 2 hours earlier than that of the the peripheral
Possible
Quantitative cultures from two different lumens of the same catheter positive for the same organism with ≥3-fold difference in CFU between lumens
Management
Short-term CVC or arterial line infection
Uncomplicated: no other foci of infection, fever resolves promptly ≤72h, no other intravascular hardware, no evidence of endocarditis or suppurative thrombophlebitis, and (if S. aureus) no active malignancy or immunosuppression
Coagulase-negative staphylococci: remove catheter and treat with antibiotic for 5-7 days; if catheter not removed, do lock therapy and treat for 10-14 days
Candida: remove catheter and treat with antifungal for 14 days from first negative blood culture
Complicated: anyone not meeting above definition of uncomplicated
Remove catheter and treat with antimicrobial for 4-6 weeks, or for 6-8 weeks if osteomyelitis
Long-term CVC or port infection
Definitions of complicated and uncomplicated are same as above
Uncomplicated
Coagulase-negative staphylococci: may retain and treat with lock therapy and antibiotic for 10-14 days; remove catheter if clinical deterioration or relapse
Staphylococcus aureus: remove catheter and treat with antibiotic for 4-6 weeks (some exceptions apply)
Enterococcus: may retain and treat with lock therapy and antibiotic for 7-14 days; remove catheter if clinical deterioration or relapse
Gram-negative bacillus: remove catheter and treat with antibiotic for 7-14 days; if attempting salvage, treat with lock therapy and antibiotic for 10-14 days and reassess
Candida: remove catheter and treat with antifungal for 14 days from first negative blood culture
Success rates are likely higher when systemic antibiotics are combined with lock therapy
Prevention
Perform hand hygiene, use aseptic technique when manipulating catheter, use barrier precaution for insertion
Remove catheters as soon as they are no longer needed
Antimicrobial-impregnated catheters may be helpful
Further Reading
Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update. Clin Infect Dis. 2009:49(1):1-45. doi: 10.1086/599376
References
^Isaac See, Alison G. Freifeld, Shelley S. Magill. Causative Organisms and Associated Antimicrobial Resistance in Healthcare-Associated, Central Line–Associated Bloodstream Infections From Oncology Settings, 2009–2012. Clinical Infectious Diseases. 2016;62(10):1203-1209. doi:10.1093/cid/ciw113.
^Michelle Gompelman, Carmen Paus, Ashley Bond, Reinier P Akkermans, Chantal P Bleeker-Rovers, Simon Lal, Geert JA Wanten. Comparing success rates in central venous catheter salvage for catheter-related bloodstream infections in adult patients on home parenteral nutrition: a systematic review and meta-analysis. The American Journal of Clinical Nutrition. 2021;114(3):1173-1188. doi:10.1093/ajcn/nqab164.
