Central line-associated bloodstream infection - Revision history

Aidan at 13:23, 27 September 2024

2024-09-27T13:23:38Z

← Older revision		Revision as of 13:23, 27 September 2024
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	=== Salvage ===		=== Salvage ===

	* Success is highest with [[coagulase-negative staphylococci]] (75%), and much lower with gram-negatives, [[Staphylococcus aureus]], and polymicrobial infections (around 50%)[[CiteRef::gompelman2021co]]		* Success is highest with [[coagulase-negative staphylococci]] (75%), and much lower with gram-negatives, [[Staphylococcus aureus]], and polymicrobial infections (around 50% each)[[CiteRef::gompelman2021co]]
			* Success rates are likely higher when systemic antibiotics are combined with lock therapy

	== Prevention ==		== Prevention ==

Aidan at 17:26, 19 September 2024

2024-09-19T17:26:27Z

← Older revision		Revision as of 17:26, 19 September 2024
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	=== Microbiology ===		=== Microbiology ===

			* May differ between oncology and non-oncology patients[[CiteRef::see2016ca]]
	* May differ between oncology and non-oncology patients<ref>See I, Freifeld AG, Magill SS. Causative Organisms and Associated Antimicrobial Resistance in Healthcare-Associated, Central Line-Associated Bloodstream Infections From Oncology Settings, 2009-2012. Clin Infect Dis. 2016 May 15;62(10):1203-9. doi: 10.1093/cid/ciw113. Epub 2016 Mar 1. PMID: 26936664; PMCID: PMC4894695.</ref>
	* In that study, the most common causes were [[coagulase-negative staphylococci]], [[Staphylococcus aureus]], [[Enterobacterales]], and [[enterococci]]		* In that study, the most common causes were [[coagulase-negative staphylococci]], [[Staphylococcus aureus]], [[Enterobacterales]], and [[enterococci]]
	* Others common causes include [[Pseudomonas aeruginosa]] and [[Candida]] species		* Others common causes include [[Pseudomonas aeruginosa]] and [[Candida]] species
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	=== Salvage ===		=== Salvage ===

	* Success is highest with [[coagulase-negative staphylococci]] (75%), and much lower with gram-negatives, [[Staphylococcus aureus]], and polymicrobial infections (around 50%)<ref>Michelle Gompelman, Carmen Paus, Ashley Bond, Reinier P Akkermans, Chantal P Bleeker-Rovers, Simon Lal, Geert J A 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. ''Am J Clin Nutrition.'' 2021;114(3)~~:~~1173-1188. doi: https://doi.org/10.1093/ajcn/nqab164</ref>~~		* Success is highest with [[coagulase-negative staphylococci]] (75%), and much lower with gram-negatives, [[Staphylococcus aureus]], and polymicrobial infections (around 50%)[[CiteRef::gompelman2021co]]

	== Prevention ==		== Prevention ==

Aidan at 17:19, 29 October 2022

2022-10-29T17:19:10Z

← Older revision		Revision as of 17:19, 29 October 2022
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	**[[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		**[[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		**[[Candida]]: remove catheter and treat with antifungal for 14 days from first negative blood culture

			=== Salvage ===

			* Success is highest with [[coagulase-negative staphylococci]] (75%), and much lower with gram-negatives, [[Staphylococcus aureus]], and polymicrobial infections (around 50%)<ref>Michelle Gompelman, Carmen Paus, Ashley Bond, Reinier P Akkermans, Chantal P Bleeker-Rovers, Simon Lal, Geert J A 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. ''Am J Clin Nutrition.'' 2021;114(3):1173-1188. doi: https://doi.org/10.1093/ajcn/nqab164</ref>

	== Prevention ==		== Prevention ==

Aidan at 19:54, 19 July 2022

2022-07-19T19:54:29Z

← Older revision		Revision as of 19:54, 19 July 2022
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	== Background ==		== Background ==

			=== Microbiology ===

			* May differ between oncology and non-oncology patients<ref>See I, Freifeld AG, Magill SS. Causative Organisms and Associated Antimicrobial Resistance in Healthcare-Associated, Central Line-Associated Bloodstream Infections From Oncology Settings, 2009-2012. Clin Infect Dis. 2016 May 15;62(10):1203-9. doi: 10.1093/cid/ciw113. Epub 2016 Mar 1. PMID: 26936664; PMCID: PMC4894695.</ref>
			* In that study, the most common causes were [[coagulase-negative staphylococci]], [[Staphylococcus aureus]], [[Enterobacterales]], and [[enterococci]]
			* Others common causes include [[Pseudomonas aeruginosa]] and [[Candida]] species
			* Far less common causes included [[streptococci]] and [[Stenotrophomonas]]

			=== Definition ===

			==== Infection Control ====

	* For surveillance purposes, a CLABSI is essentially a bloodstream infection attributed to a catheter that was in place within 48 hours of blood culture		* 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		* Catheter-related bloodstream infection (CRBSI) is defined by the IDSA
	** Confirmed		* Confirmed
	*** Peripheral culture and catheter tip culture both positive for same organism		** Peripheral culture and catheter tip culture both positive for same organism
	*** Peripheral culture and catheter lumen culture both positive for same organism with either		** Peripheral culture and catheter lumen culture both positive for same organism with either
	**** Quantitative cultures showing ≥3-fold higher CFU from the catheter		*** 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		*** Time-to-positivity of the catheter culture 2 hours earlier than that of the the peripheral
	** Possible		* Possible
	*** Quantitative cultures from two different lumens of the same catheter positive for the same organism with ≥3-fold difference in CFU between lumens		** Quantitative cultures from two different lumens of the same catheter positive for the same organism with ≥3-fold difference in CFU between lumens

	==Management==		==Management==

Aidan: Text replacement - " species]]" to "]]"

2022-02-08T02:51:46Z

Text replacement - " species]]" to "]]"

Aidan at 23:52, 18 August 2020

2020-08-18T23:52:02Z

← Older revision		Revision as of 23:52, 18 August 2020
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			== Background ==

			* For surveillance purposes, a CLABSI is essentially a bloodstream infection attributed to a catheter that was in place within 48 hours of blood culture
			* 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==		==Management==
	===Short-term CVC or arterial line infection===		===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		*'''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
	** ''[[~~Staphylococcus~~ ~~aureus~~]]'': remove catheter and treat with antibiotic for ~~≥14~~ days		**[[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
	** [[~~Enterococcus~~ ~~species~~]]: remove catheter and treat with antibiotic for ~~7-14~~ days		**''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for ≥14 days
	** [[~~Gram-negative~~ ~~bacillus~~]]: remove catheter and treat with antibiotic for 7-14 days		**[[Enterococcus species]]: remove catheter and treat with antibiotic for 7-14 days
	** [[~~Candida~~ ~~species~~]]: remove catheter and treat with ~~antifungal~~ for 14 days ~~from first negative blood culture~~		**[[Gram-negative bacillus]]: remove catheter and treat with antibiotic for 7-14 days
			**[[Candida species]]: remove catheter and treat with antifungal for 14 days from first negative blood culture
	* '''Complicated:''' anyone not meeting above definition of uncomplicated		*'''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		**Remove catheter and treat with antimicrobial for 4-6 weeks, or for 6-8 weeks if osteomyelitis

	===Long-term CVC or port infection===		===Long-term CVC or port infection===

	* Definitions of complicated and uncomplicated are same as above		*Definitions of complicated and uncomplicated are same as above
	* '''Uncomplicated'''		*'''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)~~		**[[Coagulase-negative staphylococci]]: may retain and treat with lock therapy and antibiotic for 10-14 days; remove catheter if clinical deterioration or relapse
	** [[~~Enterococcus~~ ~~species~~]]: ~~may~~ ~~retain~~ and treat with ~~lock therapy and~~ antibiotic for 7-~~14 days; remove catheter if~~ ~~clinical~~ ~~deterioration~~ or ~~relapse~~		**''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for 4-6 weeks (some exceptions apply)
	** [[~~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~~		**[[Enterococcus species]]: may retain and treat with lock therapy and antibiotic for 7-14 days; remove catheter if clinical deterioration or relapse
	** [[~~Candida~~ ~~species~~]]: remove catheter and treat with ~~antifungal~~ for 14 days ~~from~~ ~~first~~ ~~negative~~ ~~blood~~ ~~culture~~		**[[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 species]]: remove catheter and treat with antifungal for 14 days from first negative blood culture

			== 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==		==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: [https://doi.org/10.1086/599376 10.1086/599376]		*Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update. ''Clin Infect Dis''. 2009:49(1):1-45. doi: [https://doi.org/10.1086/599376 10.1086/599376]

	[[Category:Endovascular infections]]		[[Category:Endovascular infections]]

Aidan: /* Management */ added long-term CVC section

2020-06-12T11:29:51Z

Management: added long-term CVC section

← Older revision		Revision as of 11:29, 12 June 2020
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	* '''Complicated:''' anyone not meeting above definition of uncomplicated		* '''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		** 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 species]]: 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 species]]: remove catheter and treat with antifungal for 14 days from first negative blood culture

	==Further Reading==		==Further Reading==

Aidan: /* Management */ formatting

2020-06-12T11:26:04Z

Management: formatting

← Older revision		Revision as of 11:26, 12 June 2020
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	** [[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		** [[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
	** ''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for ≥14 days		** ''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for ≥14 days
	** ''[[Enterococcus]]'': remove catheter and treat with antibiotic for 7-14 days		** [[Enterococcus species]]: remove catheter and treat with antibiotic for 7-14 days
	** ''[[Gram-negative bacillus]]'': remove catheter and treat with antibiotic for 7-14 days		** [[Gram-negative bacillus]]: remove catheter and treat with antibiotic for 7-14 days
	** ''[[Candida]]'': remove catheter and treat with antifungal for 14 days from first negative blood culture		** [[Candida species]]: remove catheter and treat with antifungal for 14 days from first negative blood culture
	* '''Complicated:''' anyone not meeting above definition of uncomplicated		* '''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		** Remove catheter and treat with antimicrobial for 4-6 weeks, or for 6-8 weeks if osteomyelitis

Aidan: added Management section

2020-06-12T11:25:40Z

added Management section

← Older revision		Revision as of 11:25, 12 June 2020
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			==Management==
	[https://academic.oup.com/view-large/figure/74158738/49-1-1-fig002.gif]
			===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
			** ''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for ≥14 days
			** ''[[Enterococcus]]'': remove catheter and treat with antibiotic for 7-14 days
			** ''[[Gram-negative bacillus]]'': remove catheter and treat with antibiotic for 7-14 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

			==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: [https://doi.org/10.1086/599376 10.1086/599376]

	[[Category:Endovascular infections]]		[[Category:Endovascular infections]]

Aidan: Aidan moved page Central line-associated bloodstream infections (CLABSI) to Central line-associated bloodstream infection

2020-06-12T11:18:00Z

Aidan moved page Central line-associated bloodstream infections (CLABSI) to Central line-associated bloodstream infection

← Older revision	Revision as of 11:18, 12 June 2020
(No difference)

← Older revision		Revision as of 02:51, 8 February 2022
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	**[[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		**[[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
	**''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for ≥14 days		**''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for ≥14 days
	**[[Enterococcus ~~species~~]]: remove catheter and treat with antibiotic for 7-14 days		**[[Enterococcus]]: remove catheter and treat with antibiotic for 7-14 days
	**[[Gram-negative bacillus]]: remove catheter and treat with antibiotic for 7-14 days		**[[Gram-negative bacillus]]: remove catheter and treat with antibiotic for 7-14 days
	**[[Candida ~~species~~]]: remove catheter and treat with antifungal for 14 days from first negative blood culture		**[[Candida]]: remove catheter and treat with antifungal for 14 days from first negative blood culture
	*'''Complicated:''' anyone not meeting above definition of uncomplicated		*'''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		**Remove catheter and treat with antimicrobial for 4-6 weeks, or for 6-8 weeks if osteomyelitis
Line 29:		Line 29:
	**[[Coagulase-negative staphylococci]]: may retain and treat with lock therapy and antibiotic for 10-14 days; remove catheter if clinical deterioration or relapse		**[[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)		**''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for 4-6 weeks (some exceptions apply)
	**[[Enterococcus ~~species~~]]: may retain and treat with lock therapy and antibiotic for 7-14 days; remove catheter if clinical deterioration or relapse		**[[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		**[[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 ~~species~~]]: remove catheter and treat with antifungal for 14 days from first negative blood culture		**[[Candida]]: remove catheter and treat with antifungal for 14 days from first negative blood culture

	== Prevention ==		== Prevention ==