Central Line-Associated Bloodstream Infections (CLABSI) Management

Initial Empirical Antimicrobial Therapy

The Infectious Diseases Society of America recommends starting broad-spectrum IV antibiotics immediately covering both gram-positive organisms (including MRSA) and gram-negative pathogens before culture results are available 1
Vancomycin 15-20 mg/kg IV every 8-12 hours PLUS an anti-pseudomonal beta-lactam (such as cefepime, piperacillin-tazobactam, or meropenem) should be initiated empirically 1
Therapy should be adjusted based on culture results and antimicrobial susceptibilities once available 1

The Infectious Diseases Society of America recommends immediate catheter removal for CLABSI caused by Staphylococcus aureus, Pseudomonas aeruginosa, fungi, or mycobacteria 2, 3, 4, 1
Catheter removal is also mandatory in cases of suppurative thrombophlebitis 1, endocarditis 5, tunnel infection or port pocket infection 5, and persistent bacteremia >72 hours despite appropriate antimicrobial therapy 1
For coagulase-negative staphylococci CLABSI in long-term catheters, catheter retention may be attempted using systemic antibiotics with or without antibiotic lock therapy 2, 3, 4, 1

The Infectious Diseases Society of America recommends a minimum of 14 days of systemic antimicrobial therapy after catheter removal for S. aureus, P. aeruginosa, fungi, or mycobacteria 2, 3, 4, 1
For uncomplicated CLABSI, 10-14 days of therapy is recommended for gram-negative organisms after catheter removal 1, and 7-10 days for coagulase-negative staphylococci if catheter is removed 1
For complicated CLABSI, 4-6 weeks of antimicrobial therapy is required 2, 3, 4

For Staphylococcus aureus CLABSI, the catheter should always be removed 2, 3, 4, 1, and transesophageal echocardiography (TEE) should be obtained to exclude endocarditis 5
For Pseudomonas aeruginosa CLABSI, the catheter should always be removed 2, 3, 4
For fungal CLABSI, the catheter should always be removed 2, 3, 4, 1, and echinocandin is preferred for initial therapy 5

The Infectious Diseases Society of America recommends obtaining at least 2 sets of blood cultures: one from the catheter and one from a peripheral vein 1
Differential time to positivity (DTP) >120 minutes between catheter and peripheral cultures suggests CLABSI 2, 3, 4

Hand hygiene is the most effective means of preventing CLABSI 2, 3, 4
Maximal sterile barrier precautions should be used during catheter insertion 2, 3, 4
Cutaneous antisepsis with chlorhexidine should be used during insertion 2, 3, 4
Catheters should be removed as soon as clinically appropriate 7