Central line-associated bloodstream infection

From IDWiki
Revision as of 07:29, 12 June 2020 by Aidan (talk | contribs) (: added long-term CVC section)

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

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.