Treatment of Catheter-Related Bloodstream Infection (CRBSI)

Diagnostic Approach

• The Infectious Diseases Society of America recommends obtaining paired blood cultures from both the catheter and a peripheral vein before initiating empirical antimicrobial therapy, then removing the catheter if the patient has severe sepsis, S. aureus, Pseudomonas, Candida, or persistent bacteremia beyond 72 hours despite appropriate antibiotics 1, 2
• A differential time to positivity (DTP) of ≥2 hours between catheter and peripheral samples is highly sensitive and specific for CRBSI, as stated by the Clinical Infectious Diseases journal 4, 1
• If peripheral access is impossible, the American College of Radiology suggests drawing two blood samples from different catheter lumens at different times 3, 5

Immediate Catheter Management Decision

• The Clinical Infectious Diseases journal recommends removing the catheter immediately if the patient has severe sepsis, S. aureus, Pseudomonas, Candida, or persistent bacteremia beyond 72 hours despite appropriate antibiotics 1, 2
• The American College of Radiology states that catheter salvage may be attempted in clinically stable patients with limited venous access and infections caused by coagulase-negative staphylococci, Corynebacterium jeikeium, Acinetobacter baumannii, or Stenotrophomonas maltophilia 7, 8

Empirical Antimicrobial Therapy

• The Infectious Diseases Society of America recommends vancomycin as the first-line empirical agent in settings with elevated MRSA prevalence 1, 2
• The Clinical Infectious Diseases journal suggests switching to daptomycin if vancomycin MIC values >2 μg/mL or in institutions with high prevalence of such strains 7, 1
• The American College of Radiology states that empirical antifungal therapy is indicated for septic patients with total parenteral nutrition, prolonged broad-spectrum antibiotic use, hematologic malignancy, bone marrow or solid-organ transplant, or femoral catheterization 1, 2

Pathogen-Specific Treatment Duration

• The American College of Radiology recommends 5-7 days of IV antibiotics for coagulase-negative staphylococci with catheter removal, and 10-14 days IV antibiotics plus antibiotic lock therapy with catheter retention 3, 7
• The Clinical Infectious Diseases journal states that S. aureus requires minimum 10-14 days IV antibiotics after catheter removal for uncomplicated cases, and 4-6 weeks of therapy for complicated infections 7, 1
• The Infectious Diseases Society of America recommends mandatory catheter removal and 14 days of antifungal therapy after first negative blood culture and resolution of symptoms for Candida species 1, 2

Special Populations

• The Clinical Infectious Diseases journal recommends always removing the catheter for S. aureus, Pseudomonas, or Candida infections in hemodialysis patients 2, 10
• The American College of Radiology states that indications for catheter removal in pediatric patients are similar to adults unless no alternative access exists 10

Critical Pitfalls to Avoid

• The American College of Radiology warns against delaying obtaining blood cultures before starting antibiotics, as this complicates diagnosis and pathogen identification 3, 5
• The Clinical Infectious Diseases journal advises against attempting catheter salvage with S. aureus, Pseudomonas, or Candida, as failure/delay increases mortality and hematogenous complications 7, 9