Praxis Medical Insights

Diagnosis and Definition

CRBSI is defined as a primary bloodstream infection in a patient with a central venous catheter (CVC) within 48 hours before infection development, not related to infection at another site 1
Definitive diagnosis requires one of the following: growth of the same organism from both peripheral blood culture and catheter tip culture, growth of the same organism from catheter-drawn and peripheral blood samples with colony count from catheter hub at least 3-fold greater than from peripheral vein, or differential time to positivity (DTP): Growth of the same organism from catheter-drawn blood at least 2 hours before detection in peripheral blood sample 1, 2
Obtain paired blood cultures from the catheter and a peripheral vein before initiating antimicrobial therapy 1, 3
Properly disinfect catheter hub with alcohol, alcoholic chlorhexidine (>0.5%), or tincture of iodine 1, 3

Staphylococcus aureus infections require mandatory catheter removal 2, 4
Candida species infections require mandatory catheter removal 2, 4
Tunnel or pocket infections require mandatory catheter removal 4
Consider catheter retention for Coagulase-negative staphylococci in clinically stable patients 2, 4

Start empiric therapy after obtaining blood cultures when CRBSI is suspected 1
Empiric coverage should include Vancomycin for gram-positive organisms in settings with elevated MRSA prevalence 1
Duration of therapy: Uncomplicated CRBSI with catheter removal: 10-14 days 1, 2
Consider transesophageal echocardiography (TEE) to rule out endocarditis in patients with S. aureus bacteremia 2

Duration of catheterization (>1 week significantly increases risk) 1, 5
Catheter site (femoral and jugular sites have higher infection rates than subclavian) 1, 5
Select optimal insertion site (subclavian preferred over jugular or femoral) 1
Use maximal sterile barrier precautions during insertion 1
Implement proper hand hygiene 1, 5
Use >0.5% chlorhexidine with alcohol for skin antisepsis 1

Failing to obtain appropriate cultures before initiating antimicrobial therapy 2, 3
Delaying catheter removal for infections caused by S. aureus, Pseudomonas, or Candida 2
Routine replacement of CVCs does not reduce infection rates 2, 4