How is catheter-related bacterial sepsis treated?

Updated: Feb 05, 2019
  • Author: Amber Mahmood Bokhari, MBBS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

A detailed discussion of catheter-associated infections is available in the IDSA catheter-associated line-related infections (CRBSI) guidelines. [57] IV line infections are most often due to Staphylococcus aureus (methicillin-sensitive S aureus [MSSA] or methicillin-resistant S aureus [MRSA]) ,but gram-negative bacilli can be involved. The preferred empiric therapy for these infections is meropenem or cefepime (for Pseudomonas) plus additional coverage for staphylococci. [35, 36] If MRSA is prevalent in the institution, add linezolid, vancomycin, or daptomycin. Otherwise, nafcillin, oxacillin, or cefazolin provides adequate coverage for MSSA.

Unless coagulase-negative, methicillin-sensitive staphylococci are recovered from the blood, with high-level bacteremia (3 or 4 positive blood cultures out of 4), avoid vancomycin for empiric therapy if possible; these are low-virulence organisms and may represent contaminants. If treatment is advised, the duration of therapy depends on the severity and site of infection. [57]

Treatment of staphylococcal central line infection and fungal or gram-negative organisms typically requires removal of the line.

Minimize the use of vancomycin in order to prevent the emergence of vancomycin-resistant enterococci (VRE). [35]


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