Nosocomial infections

CR-BSIs (Catheter-related Blood Stream Infections)

General Principles

• • CR-BSIs should be suspected in any febrile patient with a central catheter.

  • Clinical findings that increase suspicion of CR-BSIs are local inflammation or phlebitis at the CVC insertion site, sepsis, endophthalmitis, lack of another source of bacteremia, and resolution of fever after catheter removal.

  • CVC removal is preferred but may involve complex decision making with consideration of host status, need for and type of vascular access, and the identified pathogen. Remove CVC in the following settings:

    • Insertion-site or tunnel-site infection (i.e., pus or significant inflammation at the site).

    • Candida, S. aureus, and most gram-negative CR-BSIs.

    • Immunocompromised patients who have fever, neutropenia, and hemodynamic instability.

    • Nontunneled CVCs should generally be removed for CR-BSIs caused by organisms other than coagulase-negative staphylococci.

    • Antibiotic lock therapy is an option that may be used to help salvage CVCs.

  • S. aureus, S. epidermidis (coagulase-negative staphylococci)