Central line-associated bloodstream infection: Difference between revisions
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(ββ: added long-term CVC section) |
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+ | == Background == |
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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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+ | * 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 β₯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 β₯3-fold difference in CFU between lumens |
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+ | |||
==Management== |
==Management== |
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===Short-term CVC or arterial line infection=== |
===Short-term CVC or arterial line infection=== |
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+ | |||
β | * |
+ | *'''Uncomplicated:''' no other foci of infection, fever resolves promptly β€72h, no other intravascular hardware, no evidence of endocarditis or suppurative thrombophlebitis, and (if [[S. aureus]]) no active malignancy or immunosuppression |
β | ** [[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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β | ** |
+ | **[[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 |
β | ** |
+ | **''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for β₯14 days |
β | ** |
+ | **[[Enterococcus species]]: remove catheter and treat with antibiotic for 7-14 days |
β | ** |
+ | **[[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 |
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β | * |
+ | *'''Complicated:''' anyone not meeting above definition of uncomplicated |
β | ** |
+ | **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=== |
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+ | |||
β | * |
+ | *Definitions of complicated and uncomplicated are same as above |
β | * |
+ | *'''Uncomplicated''' |
β | ** [[Coagulase-negative staphylococci]]: may retain and treat with lock therapy and antibiotic for 10-14 days; remove catheter if clinical deterioration or relapse |
||
β | ** |
+ | **[[Coagulase-negative staphylococci]]: may retain and treat with lock therapy and antibiotic for 10-14 days; remove catheter if clinical deterioration or relapse |
β | ** |
+ | **''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for 4-6 weeks (some exceptions apply) |
β | ** |
+ | **[[Enterococcus species]]: may retain and treat with lock therapy and antibiotic for 7-14 days; remove catheter if clinical deterioration or relapse |
β | ** |
+ | **[[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== |
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+ | |||
β | * |
+ | *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]] |
Revision as of 19:52, 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 β₯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 β₯3-fold difference in CFU between lumens
- Confirmed
Management
Short-term CVC or arterial line infection
- Uncomplicated: no other foci of infection, fever resolves promptly β€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 β₯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
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 LineβAssociated Bloodstream Infections From Oncology Settings, 2009β2012. 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.