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Catheter-related bloodstream infection

Guidelines

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 World Health Organization (WHO 2024), the Society for Healthcare Epidemiology of America (SHEA 2022), the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC/SEMICYUC 2018), the European Society of Medical Oncology (ESMO 2015), the American Society ...
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Screening and diagnosis

Diagnosis: as per SEIMC/SEMICYUC 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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Diagnostic investigations

Initial blood culture: as per SEIMC/SEMICYUC 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

Medical management

General principles: as per IDSA 2009 guidelines, 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

Therapeutic procedures

Catheter removal
As per SEIMC/SEMICYUC 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

Specific circumstances

Patients on hemodialysis: as per SEIMC/SEMICYUC 2018 guidelines, 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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  • Patients with cancer (primary prevention)

  • Patients with cancer (catheter insertion technique)

  • Patients with cancer (blood and exit site cultures)

  • Patients with cancer (initiation of antibiotic therapy)

  • Patients with cancer (duration of antibiotic therapy)

  • Patients with cancer (antibiotic lock therapy)

  • Patients with cancer (coagulase-negative Staphylococcus catheter infection)

  • Patients with cancer (S. aureus catheter infection)

  • Patients with cancer (Enterococcus catheter infection)

  • Patients with cancer (Gram-negative bacilli catheter infection)

  • Patients with cancer (fungal catheter infection)

Preventative measures

Hand hygiene: as per WHO 2024 guidelines, perform hand hygiene at any time indicated according to the "Five moments" during catheter insertion, maintenance, access, and removal practices, preferably using the hand rub technique with alcohol-based hand rub products (allow hands to dry) or washing hands with soap and water and drying with single-use or clean towels.
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  • Insertion technique (choice of catheter)

  • Insertion technique (choice of insertion site)

  • Insertion technique (insertion pack/kit)

  • Insertion technique (preparation)

  • Insertion technique (use of gloves)

  • Insertion technique (local anesthesia)

  • Insertion technique (ultrasound guidance)

  • Insertion technique (dressing)

  • Insertion technique (hospital policies)

  • Catheter maintenance

  • Catheter removal

  • Healthcare professional training

Follow-up and surveillance

Blood culture retesting: as per SEIMC/SEMICYUC 2018 guidelines, obtain follow-up blood cultures in all patients with S. aureus or Candida spp. CRBIs.
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  • New catheter insertion