Bacteremia & Line Infections

Infection & Sepsis · ICU Decoded chapter 38 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to IDSA CRBSI 2009 · IDSA/ESCMID S. aureus bacteremia 2026 Part 1.

Key points

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: TTE, selected TEE and repeat cultures to clearance; 14 days if adequate workup excludes a deep/metastatic focus and illness resolves. Longer for a confirmed focus or unresolved/prolonged bacteremia; ID review.
Selected stable long-term lines with low-virulence organisms may be salvaged using systemic antibiotics plus lock; remove for deterioration or persistent cultures at 72 h.

Investigations

First tests: Blood cultures, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine.

Only if indicated: Catheter tip culture, Bedside echocardiography, Imaging for an endovascular/deep focus.

Repeat monitoring: Blood cultures.

Management pathways in this chapter

Workup of Suspected Catheter-Associated Bacteremia

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The pathway step by step, with its decision points
Treatment orders with doses
Why and when to send each test

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