Guidelines for the Management of Intravascular Catheter-Related Infections

Abstract

These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications.Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci,Staphylococcus aureus, aerobic gram-negative bacilli, andCandida albicansmost commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical iv antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen (s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed.

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

“…S. aureus follows CoNS as the major bacterium causing CLABSI, responsible for 14 to 41% of CLABSIs (624)(625)(626)(627). S. aureus CLABSI is associated with a 7 to 21% mortality rate (612,(628)(629)(630)(631)(632) and has been estimated to cost $9,830 to $14,136 per episode (633).…”

“…Clinical features of CLABSI are usually nonspecific. Fever, erythema, tenderness, induration, and/or purulence at the catheter insertion site may suggest catheter infection (628,630,632,640). Purulence at the catheter insertion site is much more common in CLABSIs due to S. aureus than in those due to Gram-negative rods (50% versus 2.4%; P Ͻ 0.01) (641).…”

“…access that the risk imposed by attempting to retain the infected vascular access point is exceeded by the risk of removing it. In such desperate situations, adjunctive antibiotic lock therapy, in which antibiotics are instilled into the catheter lumen for extended periods, should be considered in addition to parenteral therapy (628,647,653).…”

Prävention Gefäßkatheterassoziierter Infektionen

“…Hinweise zum Vorgehen bei vermuteter oder nachgewiesener Infektion eines partiell implantierten Katheters finden sich in den entsprechenden Empfehlungen der Fachgesellschaften [90,91]. …”

Correlation of Checkerboard Synergy Testing with Time-Kill Analysis and Clinical Outcomes of Extensively Drug-Resistant Acinetobacter baumannii Respiratory Infections

“…Pneumonia was defined as having signs and symptoms of respiratory tract infection (a cough, a body temperature of Ͼ38°C, or a white blood cell count of Ͻ4,000 or Ͼ12,000, and an infiltrate identified on a chest radiograph (8). Bacteremia was defined as a positive blood culture and the presence of signs and symptoms of systemic inflammation (9).…”