Management of Catheter-Related Bloodstream Infections (CRBSI)

Diagnosis

• The Infectious Diseases Society of America recommends obtaining paired blood samples for culture from the catheter and a peripheral vein before starting antibiotic therapy 1, 3
• A differential time to positivity (DTTP) of ≥2 hours is highly sensitive and specific for CRBSI, as stated by the Clinical Nutrition guidelines 4, 3
• When peripheral blood samples cannot be obtained, the Annals of Oncology guidelines suggest collecting two blood samples from different catheter lumens at different times 5
• The Annals of Oncology guidelines recommend using alcohol, iodine tincture, or alcoholic chlorhexidine (10.5%) for skin preparation before collecting cultures 5

Management Algorithm

• The Clinical Infectious Diseases guidelines recommend assessing the severity of infection and removing the catheter immediately if the patient has sepsis, hypotension, or organ failure 1, 3
• The Clinical Infectious Diseases guidelines suggest initiating empirical antimicrobial therapy with coverage for gram-positive organisms and a gram-negative agent based on local antibiogram 6, 3

Catheter Management Based on Pathogen

• The Clinical Infectious Diseases guidelines recommend removing the catheter and treating with systemic antibiotics for Staphylococcus aureus, Pseudomonas species, or Candida species infections 1, 7
• The Journal of the American College of Radiology guidelines suggest that catheter retention may be considered for coagulase-negative staphylococci or Corynebacterium jeikeium infections in clinically stable patients 9, 7

Antimicrobial Treatment

• The Clinical Infectious Diseases guidelines recommend a treatment duration of 5-7 days for coagulase-negative staphylococci if the catheter is removed, and 10-14 days if the catheter is retained 1, 7, 3
• The Clinical Infectious Diseases guidelines suggest a treatment duration of 4-6 weeks for complicated Staphylococcus aureus infections and 2 weeks for uncomplicated infections with prompt resolution of symptoms 1, 3

Special Considerations

• The Clinical Infectious Diseases guidelines recommend always removing the catheter for hemodialysis CRBSI due to S. aureus, Pseudomonas, or Candida 6
• The Clinical Infectious Diseases guidelines suggest performing transesophageal echocardiography (TEE) to rule out endocarditis in patients with S. aureus bacteremia 1, 3

Prevention Strategies

• The Journal of the American College of Radiology guidelines recommend avoiding routine replacement of CVCs to prevent infection 7
• The Journal of the American College of Radiology guidelines suggest avoiding routine guidewire exchanges of non-tunneled CVCs 7

Common Pitfalls

• The Annals of Oncology guidelines warn against failing to obtain appropriate cultures before initiating antimicrobial therapy 5, 3
• The Clinical Infectious Diseases guidelines caution against delaying catheter removal for infections caused by S. aureus, Pseudomonas, or Candida 1, 7