Central Line-Associated Bloodstream Infection Management

Algorithm Steps

1. ▶

   Start

   Suspected CLABSI

   Bacteremia + central line with no other source

   1. ●

      Action

      Blood Cultures

      Paired peripheral and catheter cultures

      • At least 2 sets from different sites
      • One from catheter hub, one peripheral
      • Differential time to positivity may help diagnosis
      1. ●

         Action

         Empiric Antibiotics

         Cover gram-positive, consider gram-negative

         • Vancomycin 15-20mg/kg IV q8-12h
         • ADD Gram-negative coverage if: Severe sepsis, immunocompromised, femoral line
         • Piperacillin-tazobactam or Cefepime
         1. ◆

            Decision

            Remove Central Line?

            Preferred for most CLABSI

            1. ●

               Action

               LINE REMOVAL Recommended

               For most situations

               • S. aureus: Always remove
               • Candida: Always remove
               • P. aeruginosa: Always remove
               • Tunnel infection/port abscess: Remove
               • Septic shock/endocarditis: Remove
               1. ◆

                  Decision

                  Organism Identification

                  1. ●

                     Action

                     S. aureus

                     High risk for complications

                     • Remove line (mandatory)
                     • TEE for endocarditis
                     • Duration: 4-6 weeks if complicated, 2 weeks if uncomplicated
                     • MSSA: Nafcillin; MRSA: Vancomycin/Daptomycin
                     1. ●

                        Action

                        Echocardiogram

                        TEE preferred for S. aureus

                        • Recommended for all S. aureus CLABSI
                        • Consider for persistent bacteremia
                        • Assess for endocarditis
                        1. ✓

                           Outcome

                           Resolved

                           Negative cultures, completed therapy

                        2. ⚠

                           Warning

                           Complications

                           Endocarditis, septic thrombosis, metastatic infection

                  2. ●

                     Action

                     Coag-Negative Staph

                     Most common pathogen

                     • Can attempt salvage if uncomplicated
                     • Duration: 5-7 days if line removed
                     • 10-14 days if line retained + lock therapy
                  3. ●

                     Action

                     Candida

                     Fungemia

                     • Remove line (mandatory)
                     • Echinocandin: Caspofungin, Micafungin, or Anidulafungin
                     • Duration: 14 days from first negative culture
                     • Dilated eye exam for endophthalmitis
                  4. ●

                     Action

                     Gram-Negative Rod

                     P. aeruginosa high-risk

                     • Pseudomonas: Remove line, 7-14 days
                     • Enterobacteriaceae: 7-14 days
                     • Targeted therapy based on susceptibilities
            2. ●

               Action

               Salvage (Keep Line)

               Limited situations only

               • CoNS without complications
               • No tunnel infection, no endocarditis
               • Line is critical/difficult to replace
               • Antibiotic lock therapy + systemic antibiotics