Catheter Related Blood Stream Infection Review

An infection that occurs when bacteria enter the bloodstream through a central vascular catheter, which is a tube inserted into a large vein for access to the bloodstream.

CRBSI can lead to complications like fever, chills, inflammation, sepsis (body-wide infection), and even death. The severity of complications depends on the type of bacteria and the patient's overall health.

CRBSI is classified based on the severity of symptoms, ranging from mild (fever only) to severe (sepsis or organ failure). This classification helps determine the appropriate treatment plan.

A definitive diagnosis of CRBSI usually requires blood cultures, which identify the specific bacteria causing the infection. However, other factors, like symptoms and the presence of a central vascular catheter, also support the diagnosis.

The main goal of CRBSI therapy is to eradicate the infection by killing the bacteria. This is achieved through intravenous antibiotics tailored to the specific bacterium identified.

CRBSI treatment often involves intravenous antibiotics, but alternative therapies are also available. These therapies might include removing the catheter, adjusting the placement technique, or using antimicrobial catheters. The choice depends on the severity of the infection and the patient's condition.

Antibiotics used to treat CRBSI are selected based on their effectiveness against the identified bacteria and their safety for the patient. Careful consideration is given to the specific characteristics of each antibiotic, like how they work in the body, their potential side effects, and interactions with other medications.

Patient counseling is crucial for successful CRBSI management. Patients should receive information about the infection, the importance of completing the entire antibiotic course, potential side effects, and lifestyle modifications. Patient education empowers them to take an active role in their recovery.

A central venous catheter, either non-tunneled or tunneled, temporary or permanent, used to dialyze the blood.

A surgically implanted central catheter with a tunneled portion under the skin and a cuff just inside the exit site. It's intended for long-term use (over 30 days).

Implantable subcutaneous port or reservoir for self-sealing septum tunneled beneath the skin, accessed by a needle through the skin. Intended for long-term use.

Infection at the catheter exit site, characterized by exudate, erythema, induration, and/or tenderness, but negative blood cultures.

Infection along the subcutaneous tunnel of the catheter, indicated by erythema, induration, and/or tenderness more than 2 cm proximal to the exit site, with negative blood cultures.

Infection in the subcutaneous pocket of an implanted port site, usually associated with tenderness, erythema, and/or swelling over the pocket/port area with negative blood cultures.

Two blood samples, one from the CVC lumen and one from a peripheral site, grow the same organism with significant differences in time to positivity (DTTP).

Two or more lumens of a CVC are positive for the same organism when a peripheral blood culture cannot be obtained.

A CVC is in place, at least one positive blood culture with a pathogen, and clinical signs of infection with no other apparent source.

A single blood culture from any site growing a common skin contaminant likely represents a contaminated blood culture.

A single positive blood culture growing coagulase-negative staphylococci or other common skin contaminants. The patient has clinical suspicion for infection and needs additional blood cultures from the CVC and peripheral site for diagnosis.

Blood cultures positive with skin flora can represent true infection, especially with multiple positive blood cultures from different sites growing the same organism.

It is necessary to consider the likelihood of a true infection even if the organism is otherwise considered a commensal organism.

The presence of multiple positive blood cultures from different sites growing the same organism strongly suggests a true infection, even if the organism is considered a commensal.

The time taken for growth of bacteria in blood culture tubes to be visible. Shorter time to positivity suggests a higher likelihood of infection.

A blood culture drawn from a peripheral vein, which is not directly connected to a central line.

A blood culture drawn from a central line, potentially indicating the source of infection.

A time difference greater than 2 hours between positive blood cultures from a central line and a peripheral vein suggests that the central line is the likely source of infection.

The presence of a central line, along with symptoms like fever and chills, points towards a potential CRBSI. However, further confirmation is needed with blood cultures.

The goal of treatment for CRBSI is to eradicate the infection by killing the bacteria causing it.

In addition to antibiotics, possible treatment strategies for CRBSI can include removing the contaminated central line, adjusting line placement techniques, or switching to antimicrobial catheters.

Vancomycin is a glycopeptide antibiotic that is used to treat serious infections caused by bacteria that are resistant to other antibiotics.

Vancomycin is available in IV and oral forms, but only the IV form is used to treat CRBSI, as the oral form is not absorbed well into the bloodstream.

Vancomycin requires renal dosing, meaning the dosage needs to be adjusted based on the patient's kidney function. It can cause side effects like nephrotoxicity (kidney damage), ototoxicity (hearing loss), and red man syndrome (a rash).

If a patient has a penicillin allergy, they may also be allergic to other beta-lactam antibiotics. This is important to consider when choosing antibiotics for treating CRBSI.

In general, a patient can be switched from IV antibiotics to oral antibiotics when they are clinically stable and their infection is well-controlled. This allows for easier administration and improved patient comfort.

Treating CRBSI aims to eliminate the infection by killing the bacteria causing it, usually with intravenous antibiotics tailored to the specific type of bacteria identified.

Vancomycin, linezolid, daptomycin, ceftaroline, telvancin, oritavancin, dalbavancin, tigecycline, omadacycline, eravacycline, and delafloxacin.

Antibiotics are chosen based on their effectiveness against the specific bacteria identified in the blood culture and their safety for the patient, including possible side effects and interactions with other medications.

Provide the name, dose, route, frequency, and duration of the antibiotic. Explain how to take the medication, if needed. Inform the patient about potential side effects and when they should start feeling better.

The selected antibiotic, its duration, at least one major side effect, and when the patient should start feeling better. Explain your rationale for choosing the specific antibiotic.

Review if the medication is working by checking the patient's vital signs, physical exam, and blood culture results. Monitor for any potential side effects or complications related to the medication.

Factors considered include the patient's overall health, the severity of infection, and potential risks of side effects, allergies, and drug interactions. If the chosen medication is posing a risk, alternative options may be considered.

If the medication is deemed safe, the patient should receive a clear explanation of the treatment plan, including the name of the antibiotic, how to take it, expected side effects, and when they should start feeling better.