Management of Central Line-Associated Fever

Initial Diagnostic Approach

The Infectious Diseases Society of America recommends obtaining two sets of blood cultures, one from the central line and one from a peripheral vein, to calculate differential time to positivity (DTTP) 3, 4
A DTTP of ≥2 hours is highly sensitive and specific for catheter-related infection, according to the European Society for Clinical Nutrition and Metabolism 5
The American College of Clinical Nutrition suggests collecting cultures before initiating antimicrobial therapy to maximize diagnostic yield, although this specific recommendation is from the Clinical Nutrition journal 3, 4
Examination of the catheter insertion site for signs of infection, including erythema, tenderness, or drainage, is recommended by the Infectious Diseases Society of America 1, 7

The Infectious Diseases Society of America recommends removing the catheter if fever occurs when flushing the line, indicating intraluminal infection, for patients with short-term central venous catheters 1, 2
Removal of the catheter is also recommended for signs of local infection at the exit site, clinical signs of sepsis, or positive paired blood cultures, as suggested by the Clinical Nutrition journal and the Infectious Diseases Society of America 1, 2, 3, 4, 7, 8
After catheter removal, culturing the catheter tip using the roll plate technique and continuing appropriate antimicrobial therapy based on culture results are recommended by the Infectious Diseases Society of America 1, 2, 3, 7

Treatment according to the identified organism is recommended, with specific durations for coagulase-negative staphylococci (5-7 days), Staphylococcus aureus (4-6 weeks), Enterococcus (7-14 days), Gram-negative bacilli (7-14 days), and Candida species (14 days after the first negative blood culture), as suggested by the Infectious Diseases Society of America 1, 2, 7
The Infectious Diseases Society of America recommends transesophageal echocardiography in patients with S. aureus bacteremia to rule out endocarditis, although this specific recommendation is from the Clinical Nutrition journal 4

For patients with long-term dependence on central venous access, consideration of infectious disease consultation to guide management is recommended by the Clinical Nutrition journal 6