Central line-associated bloodstream infection: Difference between revisions

Revision as of 23:52, 18 August 2020

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

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 species: 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
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 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

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

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.

@@ Line 1: / Line 1: @@
+== 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==
 ===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===
-* 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==
-*  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]]