Central line-associated bloodstream infection: Difference between revisions
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== Background == |
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= Central line-associated bloodstream infections (CLABSI) = |
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=== Microbiology === |
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[[File:image-20190727112942234.png|image-20190727112942234]] |
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* May differ between oncology and non-oncology patients[[CiteRef::see2016ca]] |
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* In that study, the most common causes were [[coagulase-negative staphylococci]], [[Staphylococcus aureus]], [[Enterobacterales]], and [[enterococci]] |
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* Others common causes include [[Pseudomonas aeruginosa]] and [[Candida]] species |
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* Far less common causes included [[streptococci]] and [[Stenotrophomonas]] |
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=== Definition === |
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==== Infection Control ==== |
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* For surveillance purposes, a CLABSI is essentially a bloodstream infection attributed to a catheter that was in place within 48 hours of blood culture |
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==== IDSA ==== |
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* Catheter-related bloodstream infection (CRBSI) is defined by the IDSA |
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* Confirmed |
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** Peripheral culture and catheter tip culture both positive for same organism |
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** Peripheral culture and catheter lumen culture both positive for same organism with either |
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*** Quantitative cultures showing ≥3-fold higher CFU from the catheter |
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*** Time-to-positivity of the catheter culture 2 hours earlier than that of the the peripheral |
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* Possible |
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** Quantitative cultures from two different lumens of the same catheter positive for the same organism with ≥3-fold difference in CFU between lumens |
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==Management== |
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===Short-term CVC or arterial line infection=== |
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*'''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 |
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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 |
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**''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for ≥14 days |
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**[[Enterococcus]]: remove catheter and treat with antibiotic for 7-14 days |
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**[[Gram-negative bacillus]]: remove catheter and treat with antibiotic for 7-14 days |
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**[[Candida]]: remove catheter and treat with antifungal for 14 days from first negative blood culture |
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*'''Complicated:''' anyone not meeting above definition of uncomplicated |
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**Remove catheter and treat with antimicrobial for 4-6 weeks, or for 6-8 weeks if osteomyelitis |
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===Long-term CVC or port infection=== |
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*Definitions of complicated and uncomplicated are same as above |
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*'''Uncomplicated''' |
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**[[Coagulase-negative staphylococci]]: may retain and treat with lock therapy and antibiotic for 10-14 days; remove catheter if clinical deterioration or relapse |
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**''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for 4-6 weeks (some exceptions apply) |
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**[[Enterococcus]]: may retain and treat with lock therapy and antibiotic for 7-14 days; remove catheter if clinical deterioration or relapse |
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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 |
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**[[Candida]]: remove catheter and treat with antifungal for 14 days from first negative blood culture |
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=== Salvage === |
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* Success is highest with [[coagulase-negative staphylococci]] (75%), and much lower with gram-negatives, [[Staphylococcus aureus]], and polymicrobial infections (around 50% each)[[CiteRef::gompelman2021co]] |
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* Success rates are likely higher when systemic antibiotics are combined with lock therapy |
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== Prevention == |
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* Perform hand hygiene, use aseptic technique when manipulating catheter, use barrier precaution for insertion |
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* Remove catheters as soon as they are no longer needed |
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* Antimicrobial-impregnated catheters may be helpful |
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==Further Reading== |
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*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] |
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[[Category:Endovascular infections]] |
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Latest revision as of 13:23, 27 September 2024
Background
Microbiology
- May differ between oncology and non-oncology patients1
- 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
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
- 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
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
Salvage
- Success is highest with coagulase-negative staphylococci (75%), and much lower with gram-negatives, Staphylococcus aureus, and polymicrobial infections (around 50% each)2
- 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.
