Central line-associated bloodstream infection: Difference between revisions

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(β†’β€: 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==
 
===Short-term CVC or arterial line infection===
  
===Short-term CVC or arterial line infection===
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βˆ’
* '''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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*'''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
βˆ’
** [[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
  
βˆ’
** ''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for β‰₯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
βˆ’
** [[Enterococcus species]]: remove catheter and treat with antibiotic for 7-14 days
 +
**''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for β‰₯14 days
βˆ’
** [[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
βˆ’
** [[Candida species]]: remove catheter and treat with antifungal for 14 days from first negative blood culture
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**[[Gram-negative bacillus]]: remove catheter and treat with antibiotic for 7-14 days
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**[[Candida species]]: remove catheter and treat with antifungal for 14 days from first negative blood culture
βˆ’
* '''Complicated:''' anyone not meeting above definition of uncomplicated
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*'''Complicated:''' anyone not meeting above definition of uncomplicated
βˆ’
** Remove catheter and treat with antimicrobial for 4-6 weeks, or for 6-8 weeks if osteomyelitis
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**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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βˆ’
* Definitions of complicated and uncomplicated are same as above
 +
*Definitions of complicated and uncomplicated are same as above
βˆ’
* '''Uncomplicated'''
 +
*'''Uncomplicated'''
βˆ’
** [[Coagulase-negative staphylococci]]: may retain and treat with lock therapy and antibiotic for 10-14 days; remove catheter if clinical deterioration or relapse
  
βˆ’
** ''[[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
βˆ’
** [[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)
βˆ’
** [[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
βˆ’
** [[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 ==
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* 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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βˆ’
* 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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*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

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
  • 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

  1. ^  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.
  2. ^  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.

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