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Central venous catheter infection
CVCI is an umbrella term for diseases related to infection of central venous catheter components (including catheter colonization, exit-site infection, tunnel infection, pocket infection, septic thrombophlebitis, and bloodstream infection).
The pathogenesis of CVCI is most commonly related to extraluminal colonization originating from the skin and, less commonly, from hematogenous seeding of the catheter tip, or intraluminal colonization of the hub. Common bacterial etiologies include S. aureus (40%), Candida species (16%), P. aeruginosa (16%), coagulase negative staphylococci (8%), E. coli (8%), K. pneumoniae (8%), and Acinetobacter baumanii (4%).
In patients with central venous catheters, the incidence of catheter-related bloodstream infection is estimated at 0-2.9 cases per 1,000 days of catheter use.
Local infection may progress to bacteremia, which may result in severe sepsis and metastatic infectious complications (infective endocarditis, septic arthritis, osteomyelitis, spinal epidural abscess, and septic emboli).
Prognosis and risk of recurrence
CVCI is associated with in-hospital mortality of 10.1%.
The following summarized guidelines for the evaluation and management of central venous catheter infection are prepared by our editorial team based on guidelines from the European Society of Medical Oncology (ESMO 2015) and the American Society of Clinical Oncology (ASCO 2013).
Blood and exit site cultures: as per ESMO 2015 guidelines, perform blood cultures before starting antibiotic treatment.
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Initiate empirical antibiotic treatment with vancomycin before blood culture results are available in patients with suspected catheter-related bloodstream infection.
Initiate empirical anti-Gram-negative bacilli antibiotics (fourth-generation cephalosporins, carbapenem or β-lactam/β-lactamase inhibitor combinations with or without an aminoglycoside) in patients with severe symptoms.
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Duration of treatment
Antibiotic lock therapy
Catheter insertion technique: as per ESMO 2015 guidelines, use strict sterile precautions when performing insertion of an implantable venous access device, in the operating room.
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Coagulase-negative Staphylococcus catheter infection
Diagnose CVCI on the basis of more than one set of positive blood cultures, preferentially with a culture from both the catheter and a peripheral vein.
Attempt to salvage the catheter with systemic antibiotic therapy for 10-14 days, if there are no complications.
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S. aureus catheter infection
Enterococcus catheter infection
Gram-negative bacilli catheter infection
Fungal catheter infection
Primary prevention: as per ESMO 2015 guidelines, educate and train healthcare personnel who insert and maintain catheters.