Infectious Diseases I
Complicated CLABSI
Endocarditis; immunosuppression (S. aureus only); diabetes (S. aureus only); chronic
intravascular hardware; osteomyelitis; positive blood cultures greater than 72 hours from
initiation of appropriate therapy; septic thrombus; thrombophlebitis
ii.
Remove catheter.
iii.
Treat with pathogen-targeted antimicrobial therapy for 4β6 weeks; 6β8 weeks for osteomyelitis.
Uncomplicated CLABSI
Coagulase-negative staphylococci
| (a) | Consider catheter removal. If catheter is retained, consider antibiotic lock therapy in |
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addition to systemic antibiotic therapy for 10β14 days.
| (b) | Treat with systemic antibiotic therapy for 5β7 days if the catheter is removed. |
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ii.
S. aureus
| (a) | Remove catheter. |
|---|---|
| (b) | Treat with systemic antibiotic therapy for a minimum of 14 days. |
| (1) | Methicillin-sensitive S. aureus (MSSA) β Penicillinase-resistant penicillin (e.g., |
nafcillin); first-generation cephalosporin (e.g., cefazolin) (Note: Vancomycin has
been shown inferior to Ξ²-lactam therapy for MSSA.)
| (2) | MRSA β Vancomycin; daptomycin or linezolid; sulfamethoxazole/trimethoprim |
|---|---|
| (c) | Patients with catheter tip bacterial growth but negative blood cultures should receive |
antibiotic therapy for 5β7 days with close monitoring for signs and symptoms of ongoing
infection and consideration for repeat blood cultures.
iii.
Enterococcus spp.
| (a) | Remove catheter. |
|---|---|
| (b) | Treat with systemic antibiotic therapy for 7β14 days. |
iv.
Gram-negative bacilli
| (a) | Remove catheter. |
|---|---|
| (b) | Treat with systemic antibiotic therapy for 7β14 days. |
Candida spp.
| (a) | Remove catheter. |
|---|---|
| (b) | Treat with systemic antifungal therapy for at least 14 days. |
vi.
Antibiotic lock therapy in the treatment of CLABSI should be used primarily for catheter
salvage. In the event antibiotic therapy cannot be used in this situation, then recommendation is
to administer antibiotics through the colonized catheter.
Patient Cases
T.W. is a 47-year-old woman admitted to the MICU with respiratory failure secondary to severe 2009 H1N1
influenza infection. T.W., who requires intubation and mechanical ventilation, is given a diagnosis of septic
shock associated with influenza and a secondary MSSA pneumonia. An internal jugular vein CVC was
placed in the ED during acute resuscitation. T.W. continues to require a CVC. Although her hypotension
and fever resolved 72 hours post-admission, she has a new temperature of 101.7Β°F (38.7Β°C) with worsening
leukocytosis on ICU day 5; there is no change on her chest radiograph. Which action would be best to take
next?