Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC)

Abstract

Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.

Blood stream infections associated with central and peripheral venous catheters

“…In this sense patients with only one positive blood culture were considered a cause of bateremia catheter related blood stream infection if it was combined with a positive catheter hubs with the same microorganism and same antibiogram or sugestive symthoms as they have been defined before taking in account the growth time of cultures. Semiquantitative cultures of catheter hubs with ≥15 cfu (Maki method) may be indicative for catheter bacteremia if it is combined with positive blood culture with the same microorganism and same antibiogram” [13] or if the catheter was not cultured, on the presence of clinical signs of phlebitis or unexplained fever that resolved upon removal of the catheter.…”

Performance of differential time to positivity as a routine diagnostic test for catheter-related bloodstream infections: a single-centre experience

“…Catheter-related bloodstream infections (CRBSI) account for 15%e30% of all nosocomial bloodstream infections (BSI), cause an incremental cost of about V18 000 per episode, prolong length of stay and have an attributable mortality of 12%e25% in critically-ill individuals [1]. Clinical manifestations such as fever and chills are sensitive but unspecific; conversely, more specific signs such as phlebitis and inflammation or suppuration at the insertion site or tunnel have a low sensitivity.…”

“…Definitive diagnosis has traditionally relied on the removal of the catheter and culture of the tip by quantitative or semi-quantitative methods. Although withdrawing suspicious catheters may account for the relatively good prognosis of CRBSI in comparison with bacteraemia from other sources, only 15%e25% of central venous catheters removed for suspected infection are significantly colonized [1,2]. To avoid such a waste of catheters and reduce the incidence of complications derived from the insertion of new devices or the absence of needed ones, several diagnostic procedures not requiring catheter removal have been devised.…”

Is heparinized 40% ethanol lock solution efficient for reducing bacterial and fungal biofilms in an in vitro model?

“…Catheter-related bloodstream infection (C-RBSI) is one of the most problematic nosocomial infections, with high rates of morbidity and mortality, high associated costs, and prolonged hospital stays in patients with long-term catheters that cannot be removed [1, 2]. The main causative agents of C-RBSI are gram-positive cocci, gram-negative bacilli, and yeasts, owing to their capacity to form robust biofilms on the catheter surface [3, 4].…”

“…However, patients with long-term catheters and no alternative central access have to maintain their catheter in place [6]. In these cases, the main approach is to use conservative treatments based on the application of intravenous antibiotics combined with antibiotic lock therapy [1]. In a recent study published by Freire et al ., ALT was successful in 75.9% of cancer patients, with an improvement in patient outcome [7].…”