Suspected catheter-related bloodstream infection - ...
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Description

Suspected catheter-related bloodstream infection - Management Algorithm

 • Temperature 37.8 C   • Rigors   •Tunnel or exit site purulence

Obtain blood cultures from the catheter lumen and the dialysis circuit and start empiric antibiotics

Antibiotic Management - Uncomplicated CRBSI

 • Responds quickly to empiric antibiotics

 • No evidence of metastatic infection

 • Hemodynamically stable

Antibiotic Management - Complicated CRBSI - 6-8 weeks of tailored systemic antibiotics

 • Hemodynamic instability

 • Persistent fever and/or bacteremia despite appropriate antibiotic therapy

 • Evidence of metastatic infection (endocarditis, epidural abscess, osteomyelitis, septic arthritis)



Keep catheter if -Presentation is consistent

with uncomplicated CRBSI:

 • Rapid improvement after empiric antibiotics

 • No hemodynamic stability

 • No evidence of metastatic infection

Remove catheter if - Presentation is consistent with complicated CRBSI:

 • Severe sepsis

 • Hemodynamic instability

 • Evidence of tunnel or exit site infection

 • Persistent fever and/or bacteremia 48-72 hours after starting tailored antibiotics

 • Resistant pathogens (S. aureus, fungal or multidrug resistant organisms)

Exchange catheter if - Presentation is consistent with complicated CRBSI but patient has limited vascular access options and is:

 • Afebrile 48-72 hours after starting tailored antibiotics

 • Hernodynamically stable after treatment initiation

 • No evidence of tunnel or exit site infection



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Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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