Praxis Medical Insights

Diagnosis and Management

The management of CRBSI requires catheter removal for infections caused by Staphylococcus aureus, Pseudomonas, or Candida species, combined with appropriate antimicrobial therapy based on culture results and pathogen susceptibility, as recommended by the Infectious Diseases Society of America 1
Obtain paired blood cultures from the catheter and a peripheral vein before initiating antimicrobial therapy, as suggested by the Centers for Disease Control and Prevention 2
A differential time to positivity (DTTP) ≥2 hours between catheter and peripheral blood cultures is highly sensitive and specific for CRBSI, according to the Society for Healthcare Epidemiology of America 2
Growth of >15 CFU from a 5-cm segment of the catheter tip by semiquantitative (roll-plate) culture or growth of >10² CFU by quantitative (sonication) broth culture reflects catheter colonization, as defined by the Clinical and Laboratory Standards Institute 1

Initiate empirical therapy with coverage for gram-positive organisms, as recommended by the International Society for Antimicrobial Chemotherapy 2
In countries with low MRSA rates, an anti-staphylococcal beta-lactam antimicrobial could be the first option, according to the European Society of Clinical Microbiology and Infectious Diseases 4
For severe illness, neutropenic or immunocompromised patients, and those with femoral catheters, add gram-negative coverage (extended-spectrum penicillin, cephalosporin, or carbapenem) based on local antibiogram, as suggested by the Infectious Diseases Society of America 5

S. aureus infections require catheter removal, as recommended by the American College of Physicians 6
Candida species infections require catheter removal, according to the Infectious Diseases Society of America 6
Tunnel or pocket infections require catheter removal, as suggested by the Society for Healthcare Epidemiology of America 7

Implement education and ongoing training of healthcare personnel who insert and maintain catheters, as recommended by the World Health Organization 8
Use maximal sterile barrier precautions during CVC insertion, as suggested by the Centers for Disease Control and Prevention 8
Apply >0.5% chlorhexidine skin preparation with alcohol for antisepsis, according to the Society for Healthcare Epidemiology of America 8
Avoid routine replacement of CVCs as a strategy to prevent infection, as recommended by the American College of Radiology 9