Catheter Related Blood Stream Infection Review
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Questions and Answers

Which medication is primarily used for treating CRBSI in patients with potential MRSA infection?

  • Clindamycin
  • Amoxicillin
  • Ciprofloxacin
  • Vancomycin (correct)

    • Which major adverse effect is associated with nephrotoxic drugs?

  • Hepatotoxicity
  • Ototoxicity
  • Cardiotoxicity
  • Nephrotoxicity (correct)

    • In cases of beta-lactam allergy with symptoms of rash, which alternative antibiotic class is generally considered safe?

  • Glycopeptides
  • Aminoglycosides
  • Macrolides (correct)
  • Fluoroquinolones

    • When can a patient typically be switched from intravenous to oral antibiotics?

    <p>After achieving clinical stability</p> Signup and view all the answers

    Which drug requires dose adjustment in patients with renal impairment?

    <p>Vancomycin</p> Signup and view all the answers

    What is the primary goal of treatment for catheter-related bloodstream infection (CRBSI)?

    <p>To eradicate the infection</p> Signup and view all the answers

    In the case of Fergie, what was the time to positivity for the blood culture drawn from the subclavian catheter?

    <p>4 hours</p> Signup and view all the answers

    Which antibiotic was initiated for Fergie upon suspicion of infection?

    <p>Vancomycin</p> Signup and view all the answers

    What is a common major side effect associated with the use of vancomycin?

    <p>Nephrotoxicity</p> Signup and view all the answers

    Upon receiving the blood culture results, what is indicated by a time to positivity of 9 hours for the culture from the peripheral venipuncture?

    <p>The organism may have different sensitivities than the subclavian culture</p> Signup and view all the answers

    Why is it important to monitor both central and peripheral cultures in suspected CRBSI cases?

    <p>To identify potential contamination sources</p> Signup and view all the answers

    What condition was Fergie experiencing that indicated a possible infection?

    <p>Chills and fever</p> Signup and view all the answers

    What rationale supports the timing of initiating antibiotic treatment in cases of suspected CRBSI?

    <p>To decrease the risk of sepsis and improve outcomes</p> Signup and view all the answers

    What is a characteristic feature of long-term central catheters?

    <p>They include a tunneled portion under the skin.</p> Signup and view all the answers

    Which of the following types of catheters is specifically used to dialyze blood?

    <p>Hemodialysis catheters</p> Signup and view all the answers

    What distinguishes an exit site infection from a tunnel infection?

    <p>Exit site infections are identified with negative blood cultures.</p> Signup and view all the answers

    What is an essential management step when there is drainage from an exit site infection?

    <p>It must be collected for Gram staining and culture.</p> Signup and view all the answers

    What is the indication of a pocket infection associated with an implanted port?

    <p>Swelling and tenderness in the port area</p> Signup and view all the answers

    Which of the following best describes tunneled hemodialysis catheters?

    <p>They are categorized separately in guidelines.</p> Signup and view all the answers

    What is a common characteristic of all types of intravascular devices discussed?

    <p>They require management similar to long-term catheters.</p> Signup and view all the answers

    How far from the catheter exit site must tenderness be for a diagnosis of tunnel infection?

    <p>More than 2 cm</p> Signup and view all the answers

    What is the primary goal of therapy for catheter related bloodstream infection (CRBSI)?

    <p>To achieve a resolution of infection and prevent complications</p> Signup and view all the answers

    Which complication is most frequently associated with CRBSI?

    <p>Septicemia</p> Signup and view all the answers

    Which criterion is essential for diagnosing CRBSI?

    <p>At least two blood cultures positive for the same organism</p> Signup and view all the answers

    Which of the following statements about combination drug therapy for CRBSI is accurate?

    <p>It may enhance therapeutic efficacy and reduce resistance</p> Signup and view all the answers

    What is a characteristic of a peripherally inserted central catheter (PICC)?

    <p>Placed in a central vein with distal tip usually in the superior vena cava</p> Signup and view all the answers

    Which of the following is NOT a type of central vascular catheter?

    <p>Subcutaneous insulin port</p> Signup and view all the answers

    What is a common reason for lack of responsiveness to therapy in CRBSI?

    <p>Resistance of organisms to standard antibiotics</p> Signup and view all the answers

    Which of the following is a primary characteristic to monitor in patients with CRBSI?

    <p>Signs of infection resolution</p> Signup and view all the answers

    What indicates a definitive Catheter-Related Bloodstream Infection (CRBSI)?

    <p>One blood sample from the catheter and one from a peripheral site grow the same organism.</p> Signup and view all the answers

    Which condition could lead to the diagnosis of presumed CRBSI?

    <p>A single positive blood culture from the CVC with clinical signs of infection.</p> Signup and view all the answers

    What does a positive blood culture growing coagulase-negative staphylococci indicate?

    <p>Possible contamination, suggesting the need for additional blood cultures.</p> Signup and view all the answers

    What should be considered when multiple blood cultures from different sites show the same organism?

    <p>The likelihood of a true infection should be highly regarded.</p> Signup and view all the answers

    Which of the following statements about contamination in blood cultures is accurate?

    <p>Skin flora can indicate true infection under certain clinical circumstances.</p> Signup and view all the answers

    What role do clinical signs of infection play in diagnosing CRBSI?

    <p>They assist in distinguishing between true infection and contamination.</p> Signup and view all the answers

    In what situation is it necessary to rule out contamination following a positive blood culture?

    <p>When coagulase-negative staphylococci are isolated with clinical suspicion.</p> Signup and view all the answers

    How is culture contamination typically identified?

    <p>By common skin contaminants in the absence of infection signs.</p> Signup and view all the answers

    Which antibiotic listed has no renal dosage adjustments required?

    <p>Vancomycin</p> Signup and view all the answers

    Which antibiotic is associated with significant side effects that can include severe gastrointestinal issues?

    <p>Tigecycline</p> Signup and view all the answers

    Which of these antibiotics is not typically administered orally?

    <p>Vancomycin</p> Signup and view all the answers

    What is a shared benefit of Daptomycin and Oritavancin?

    <p>Effective against MRSA</p> Signup and view all the answers

    Which of the following antibiotics requires renal adjustments?

    <p>Ceftaroline</p> Signup and view all the answers

    Which antibiotic's administration route allows for both IV and oral options?

    <p>Linezolid</p> Signup and view all the answers

    What is a major side effect of Telavancin treatment that should be communicated to patients?

    <p>Hypersensitivity reactions</p> Signup and view all the answers

    Which antibiotic is known for its unique benefit of being effective against multi-drug resistant organisms?

    <p>Eravacycline</p> Signup and view all the answers

    Study Notes

    • CRBSI is an infection of the bloodstream caused by a catheter.
    • Lecture objectives included:
      • describing pathophysiology of CRBSI
      • identifying medical complications associated with CRBSI
      • identifying and classifying disease severity of CRBSI
      • describing criteria needed to diagnose CRBSI
      • establishing goals of therapy for CRBSI
      • interpreting evidence supporting the goals of therapy for CRBSI
      • recommending non-antibiotic alternative therapies for CRBSI
      • describing the efficacy of non-antibiotic alternative therapies for CRBSI
      • comparing/contrasting clinical characteristics of CRBSI agents
      • identifying evidence-based pharmacotherapy options for CRBSI
      • listing essential components of patient counseling for CRBSI
      • identifying potential causes for lack of responsiveness to therapy
      • describing combination drug therapy for CRBSI
      • devising appropriate therapy plans for patients with CRBSI
      • devising appropriate monitoring plans for patients with CRBSI

    Common Device Definitions

    • Central vascular catheter: A catheter placed in a vein or artery, intended to reach a central vein or artery.
    • Short-term central vascular catheter: A catheter used for short-term use (less than 30 days).
    • Peripherally inserted central catheter: A catheter placed in a peripheral vein and placed into a central vein.
    • Long-term central catheter: A surgically implanted catheter intended for over 30 days of use.
    • Hemodialysis catheter: A catheter used to perform dialysis.
    • Port: An implantable port located beneath the skin, used similarly to long-term catheters.

    Common Infection Definitions

    • Exit site infection: An infection at the catheter exit site, indicated by exudate, erythema, induration, or tenderness.
    • Tunnel infection: An infection deep inside of the device, along the catheter tunnel.
    • Pocket infection: An infection in the pocket where an implanted port is located.
    • Complicated infection : An infection that persists for more than 72 hours, or an infection that causes serious health problems.

    Common Infection Definitions -(Cont)

    • Severe sepsis: A life-threatening organ dysfunction caused by a dysregulated host response to infection.
    • Central Vascular Catheter Infection: Primary bloodstream infection in a patient with a central line, without another infectious source.

    Diagnosis of CRBSI

    • Definitive CRBSI: Two blood samples, one from the catheter lumen and one from a peripheral site, growing the same organism with a significant time to positivity.
    • Presumed CRBSI: A catheter is present and there is at least one positive blood culture with a pathogen from a site, other than the catheter itself.
    • Culture contamination: A single blood culture from any site that grows a contaminant, likely from the skin.

    Clinical Manifestations of CRBSI

    • Alterations in temperature (fever or hypothermia).
    • Hypotension.
    • Tachycardia.
    • Altered perfusion.
    • Tachypnea.
    • Altered mental status.
    • Abnormal skin findings (erythema, pain, swelling).
    • Discharge around the CVC exit site, tunnel, or port pocket.
    • Device requiring repair (broken or leaking).

    Diagnosis of CRBSI -(Cont)

    • Blood culture "set": Two bottles, one aerobic, one anaerobic.
    • Differential Time to Positivity (DTTP): Growth of a microbe from a catheter hub sample at least two hours before growth in a peripheral sample suggests CRBSI.

    Rapid Diagnostic Tests

    • Traditional methods for organism identification.
    • Rapid molecular methods for organism ID (Polymerase Chain Reaction, Multiplex PCR).
    • Nanoparticle Probe Technology (Nucleic Acid Extraction and PCR Amplification).
    • Peptide Nucleic Acid Fluorescent In Situ Hybridization.
    • Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry.

    Rapid ID Sample Testing: PBP2a

    • Bacteria have penicillin-binding proteins (PBPs) in their plasma membranes, which are targets for penicillin.
    • Methicillin-resistant Staphylococcus aureus (MRSA) has acquired a different PBP (PBP2a) that is less sensitive to penicillins.

    Treatment for CRBSI

    • Treatment is tailored to the identified microorganism and its susceptibilities.
    • Oral step-down therapy may be possible if appropriate.
    • Antibiotic lock therapy is a specific treatment option for infected catheters if saving the catheter is a goal.
    • Catheter removal is the preferred treatment for most cases of confirmed CRBSI, especially for Staphylococcus aureus, Pseudomonas aeruginosa, and Candida spp.

    Case Studies

    • Case studies highlight real-world examples, patient characteristics, and laboratory findings related to CRBSI.
    • Case study data may be used to guide diagnosis and treatment.

    How to treat (Examples)

    • Remove catheter
    • Close Monitoring
    • No Antibiotics
    • Repeat Cultures
    • Lock Therapy

    What is the Goal of therapy?

    • Eradicate infection (infx)
    • Salvage catheter
    • Manage patient symptoms (SIJ)
    • Manage patient condition (m/m)

    Treatment Plan -- What to Include

    • Antimicrobial regimen name, duration
    • At least one potential side effect of the regimen
    • When the patient should start feeling better
    • rationale for the regimen selection

    Monitoring Parameters

    • Signs and symptoms.
    • Laboratory tests.
    • Imaging studies.

    Determining Duration of Therapy

    • Duration is determined based on type of infection, and complexity of infection
    • 72-80hr resolution for uncomplicate infections
    • 4-14 days, 4-6 to 14 weeks, are some common durations

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    Related Documents

    Catheter Related Blood Stream Infection (CRBSI) PDF

    Description

    This quiz focuses on Catheter Related Blood Stream Infection (CRBSI), covering its pathophysiology, medical complications, and criteria for diagnosis. It also explores therapy goals, evidence-based treatments, and patient counseling. Test your knowledge on this critical topic relevant for healthcare professionals.

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