Central line-associated bloodstream infection: Difference between revisions

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== Background ==
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[https://academic.oup.com/view-large/figure/74158738/49-1-1-fig002.gif]
  
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=== Microbiology ===
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* May differ between oncology and non-oncology patients<ref>See I, Freifeld AG, Magill SS. Causative Organisms and Associated Antimicrobial Resistance in Healthcare-Associated, Central Line-Associated Bloodstream Infections From Oncology Settings, 2009-2012. Clin Infect Dis. 2016 May 15;62(10):1203-9. doi: 10.1093/cid/ciw113. Epub 2016 Mar 1. PMID: 26936664; PMCID: PMC4894695.</ref>
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* In that study, the most common causes were [[coagulase-negative staphylococci]], [[Staphylococcus aureus]], [[Enterobacterales]], and [[enterococci]]
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* Others common causes include [[Pseudomonas aeruginosa]] and [[Candida]] species
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* Far less common causes included [[streptococci]] and [[Stenotrophomonas]]
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=== Definition ===
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==== Infection Control ====
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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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==== IDSA ====
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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 ≥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 ≥3-fold difference in CFU between lumens
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==Management==
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===Short-term CVC or arterial line infection===
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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
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**[[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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**''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for ≥14 days
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**[[Enterococcus]]: remove catheter and treat with antibiotic for 7-14 days
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**[[Gram-negative bacillus]]: remove catheter and treat with antibiotic for 7-14 days
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**[[Candida]]: remove catheter and treat with antifungal for 14 days from first negative blood culture
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*'''Complicated:''' anyone not meeting above definition of uncomplicated
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**Remove catheter and treat with antimicrobial for 4-6 weeks, or for 6-8 weeks if osteomyelitis
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===Long-term CVC or port infection===
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*Definitions of complicated and uncomplicated are same as above
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*'''Uncomplicated'''
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**[[Coagulase-negative staphylococci]]: may retain and treat with lock therapy and antibiotic for 10-14 days; remove catheter if clinical deterioration or relapse
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**''[[Staphylococcus aureus]]'': remove catheter and treat with antibiotic for 4-6 weeks (some exceptions apply)
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**[[Enterococcus]]: may retain and treat with lock therapy and antibiotic for 7-14 days; remove catheter if clinical deterioration or relapse
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**[[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
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**[[Candida]]: remove catheter and treat with antifungal for 14 days from first negative blood culture
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=== Salvage ===
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* Success is highest with [[coagulase-negative staphylococci]] (75%), and much lower with gram-negatives, [[Staphylococcus aureus]], and polymicrobial infections (around 50%)<ref>Michelle Gompelman, Carmen Paus, Ashley Bond, Reinier P Akkermans, Chantal P Bleeker-Rovers, Simon Lal, Geert J A 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. ''Am J Clin Nutrition.'' 2021;114(3):1173-1188. doi: https://doi.org/10.1093/ajcn/nqab164</ref>
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== Prevention ==
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* Perform hand hygiene, use aseptic technique when manipulating catheter, use barrier precaution for insertion
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* Remove catheters as soon as they are no longer needed
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* Antimicrobial-impregnated catheters may be helpful
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==Further Reading==
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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]
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[[Category:Endovascular infections]]

Latest revision as of 13:19, 29 October 2022

Background

Microbiology

Definition

Infection Control

  • For surveillance purposes, a CLABSI is essentially a bloodstream infection attributed to a catheter that was in place within 48 hours of blood culture

IDSA

  • 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: remove catheter and treat with antibiotic for 7-14 days
    • Gram-negative bacillus: remove catheter and treat with antibiotic for 7-14 days
    • Candida: 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: 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: remove catheter and treat with antifungal for 14 days from first negative blood culture

Salvage

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
  1. ↑ See I, Freifeld AG, Magill SS. Causative Organisms and Associated Antimicrobial Resistance in Healthcare-Associated, Central Line-Associated Bloodstream Infections From Oncology Settings, 2009-2012. Clin Infect Dis. 2016 May 15;62(10):1203-9. doi: 10.1093/cid/ciw113. Epub 2016 Mar 1. PMID: 26936664; PMCID: PMC4894695.
  2. ↑ Michelle Gompelman, Carmen Paus, Ashley Bond, Reinier P Akkermans, Chantal P Bleeker-Rovers, Simon Lal, Geert J A 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. Am J Clin Nutrition. 2021;114(3):1173-1188. doi: https://doi.org/10.1093/ajcn/nqab164
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