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Catheter-related bloodstream infection

Key sources
The following summarized guidelines for the evaluation and management of catheter-related bloodstream infection are prepared by our editorial team based on guidelines from the Society for Healthcare Epidemiology of America (SHEA 2022), the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC/SEMICYUC 2018), and the Infectious Diseases Society of America (IDSA 2009).
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Guidelines

1.Screening and diagnosis

Diagnosis: as per SEIMC 2018 guidelines, suspect CRBI in patients with IV catheters and fever, chills or other signs of sepsis, even in the absence of local signs of infection and especially if no alternative source is identified.
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2.Diagnostic investigations

Initial blood culture: as per SEIMC 2018 guidelines, obtain blood cultures using an aseptic technique and before the initiation of antimicrobial therapy.
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  • Additional blood cultures

  • Catheter culture

  • TEE

3.Medical management

General principles: consider formulating automated standardized treatment advice after a positive blood culture result is reported likely to represent CRBI, to improve compliance with published evidence-based guidelines.
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  • Antimicrobial lock therapy

  • Empiric antibiotic therapy

  • Empiric antifungal therapy

  • Specific antibiotic therapy (Staphylococcus species)

  • Specific antibiotic therapy (Enterococcus species)

  • Specific antibiotic therapy (Gram-negative bacilli)

  • Specific antibiotic therapy (nontuberculous mycobacteria)

  • Specific antifungal therapy

  • Thrombolytic therapy

  • Management of insertion site infection

  • Management of tunnelitis

  • Management of subcutaneous port infection

  • Management of suppurative thrombophlebitis

4.Therapeutic procedures

Catheter removal
As per SEIMC 2018 guidelines:
Do not remove the central venous catheter immediately when CRBI is suspected in hemodynamically stable patients without immunosuppressive therapy, intravascular foreign bodies or organ transplantation, no suppuration at the insertion site or bacteremia/fungemia.
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View any clinical condition or catheter dysfunction prompting catheter removal as a failure of conservative management.
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  • Guidewire exchange

5.Specific circumstances

Patients on hemodialysis: obtain paired blood samples from the central venous catheter and a peripheral vein, whenever possible, for the diagnosis of CRBI in patients on hemodialysis.
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6.Follow-up and surveillance

Serial blood culture: obtain follow-up blood cultures in all patients with S. aureus or Candida spp. CRBIs.
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  • New catheter insertion

7.Quality improvement

Preventive strategies for hospitals, pre-insertion requirements: provide easy access to an evidence-based list of indications for central venous catheter use to minimize unnecessary central venous catheter placement.
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  • Preventive strategies for hospitals (insertion requirements)

  • Preventive strategies for hospitals (post-insertion requirements)

  • Preventive strategies for hospitals (additional measures)