Catheter related bloodstream infections (CRBSI)

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Intravascular non-hemodialysis catheter-related bloodstream infection
Definition Signs/ Symptoms Management
Initial Empirical Therapy Comment
Infection occur in association with peripheral intravascular IV catheters and central venous catheters (CVCs) Fever, inflammation or purulence at the catheter infection site, hemodynamic instability, catheter intraluminal clot and alter of mental status

Select one of the following antibiotics:

  • Vancomycin 20 - 35 mg/kg/loading then 15 - 20 mg/kg IV every 8 to 12 hours
  • Daptomycin 6 - 10 mg/kg IV every 24 hours

PLUS

(In patient with neutropenia, severe burn or hemodynamic instability)

Select one of the following antibiotics:

  • Ceftazidime 2 g IV every 8 hours
  • Cefepime 2 g IV every 8 hours
  • Piperacillin/Tazobactam 4.5 g IV every 6 hours
  • Imipenem/Cilastatin 500 mg IV every 6 hours
  • Meropenem 1 g IV every 8 hours

PLUS

(If local susceptibility < 90% to antipseudomonal beta-lactams)

Select one of the following antibiotics:

  • Gentamycin 5 - 7 mg/kg IV every 24 hours
  • Ciprofloxacin 400 mg IV every 12 hours
In absence of neutropenia, severe burn or hemodynamic instability: Vancomycin or Daptomycin PLUS Ceftriaxone 2 g IV every 24 hours is resealable.
Duration:7 -14 days in most pathogens
References:

Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by IDSA 2018