Central line-associated bloodstream infection

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

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