Bacteremia & Line Infections

• CRBSI workup uses paired peripheral plus catheter cultures; pull the line for septic shock, S. aureus, Pseudomonas, fungi, or tunnel infection.
• Start empiric vancomycin ± gram-negative cover per severity, then de-escalate by sensitivities.
• S. aureus bacteremia requires an echocardiogram and at least 2 wk IV therapy (4–6 wk if complicated).
• Use antibiotic lock for salvageable long-term lines with non-virulent organisms.

Workup of Suspected Catheter-Associated Bacteremia

• New fever with a central venous catheter (CVC) in place
• Look for other potential infection sources · draw two sets of blood cultures, at least one peripheral
• Inflamed CVC insertion site or clinical sepsis?
• Pull the CVC · culture the catheter tip · start appropriate antibiotics
• Empirical antibiotics if fever persists or the patient worsens clinically · track blood cultures
• Blood culture results?
• LIKELY PATHOGEN: Staphylococcus aureus · gram-negative bacilli · coagulase-negative staphylococci from ≥2 blood cultures · Candida spp. → pull the CVC, culture the catheter tip, start appropriate antibiotics
• POSSIBLE CONTAMINANT: one blood culture growing coagulase-negative staphylococci, Bacillus spp., Corynebacterium spp. → repeat blood cultures
• Repeat blood cultures grow the same organism?
• Pull the CVC · culture the catheter tip · start appropriate antibiotics
• Search for another infection source
• NO GROWTH → search for another infection source