Management of Permacath Catheter Infection with Vancomycin-Sensitive Blood Culture

The American College of Physicians and the Infectious Diseases Society of America recommend administering vancomycin systemically along with antibiotic lock therapy with vancomicina for 10-14 days for Permacath catheter infections with vancomycin-sensitive blood cultures, and consider catheter removal based on the specific pathogen and clinical response 1, 2

Decision to Remove or Preserve the Catheter

The Infectious Diseases Society of America indicates that catheters must be removed in cases of infection by S. aureus, Pseudomonas spp., or Candida spp., as well as in cases of severe sepsis, shock, tunnel infection, or abscess 1, 2, 3
The American College of Physicians suggests attempting to preserve the catheter in cases of infection by coagulase-negative staphylococci or other gram-negative bacilli (except Pseudomonas), if the patient is clinically stable and shows no signs of metastatic infection 2, 3

The Infectious Diseases Society of America recommends vancomycin as the treatment of choice for vancomycin-sensitive organisms, with a dose of 20 mg/kg after each dialysis session 1, 2
The American College of Physicians suggests changing to cefazolin if methicillin-sensitive S. aureus is identified, at a dose of 20 mg/kg after dialysis 2, 3

The Infectious Diseases Society of America recommends a treatment duration of 10-14 days if the catheter is removed, and 14 days if the catheter is preserved with antibiotic lock therapy 1, 2, 3
The American College of Physicians suggests a prolonged treatment duration of 4-6 weeks for complicated infections, such as persistent bacteremia, endocarditis, or suppurative thrombophlebitis 1, 2, 3

The American Heart Association recommends performing transesophageal echocardiography (TEE) in all patients with S. aureus bacteremia to identify endocarditis 3
The Infectious Diseases Society of America suggests that if TEE is negative and the catheter is removed, treatment should be continued for 14 days 3

The Infectious Diseases Society of America recommends obtaining blood cultures 1 week after completing treatment if the catheter is preserved 2
The American College of Physicians suggests removing the catheter immediately if blood cultures are positive, and placing a new catheter after obtaining negative cultures 2