Guideline sources The following summarized guidelines for the evaluation and management of central venous catheter infection (CVCI) are prepared by our editorial team based on guidelines from the European Society of Medical Oncology (ESMO 2015) and the American Society of Clinical Oncology (ASCO 2013). 1 2 3 3 3 4 5 Definition CVCI is an umbrella term for diseases related to infection of central venous catheter components (including catheter colonization, exit-site infection, tunnel infection, pocket infection, septic thrombophlebitis, and bloodstream infection). 3 Epidemiology The pathogenesis of CVCI is most commonly related to extraluminal colonization originating from the skin and, less commonly, from hematogenous seeding of the catheter tip, or intraluminal colonization of the hub. Common bacterial etiologies include S. aureus (40%), Candida species (16%), P. aeruginosa (16%), coagulase negative staphylococci (8%), E. coli (8%), K. pneumoniae (8%), and Acinetobacter baumanii (4%). 3 Pathophysiology https://web.pathway.md/diseases/rec5xK7V7Q8Acmy3K 1/4 6/29/23, 3:47 AM Central venous catheter infection Pathway In patients with central venous catheters, the incidence of catheter-related bloodstream infection is estimated at 0-2.9 cases per 1,000 days of catheter use. 4 Disease course Local infection may progress to bacteremia, which may result in severe sepsis and metastatic infectious complications (infective endocarditis, septic arthritis, osteomyelitis, spinal epidural abscess, and septic emboli). 3 Prognosis and risk of recurrence CVCI is associated with in-hospital mortality of 10.1%. 5 Guidelines 1. Diagnostic investigations Blood and exit site cultures: As per ESMO 2015 guidelines, perform blood cultures before starting antibiotic treatment. A Show 2 more As per ASCO 2013 guidelines, obtain cultures of blood from the catheter and when appropriate of soft tissues at entrance-exit sites or tunnel before initiation of antibiotic therapy. 2. Medical management Antibiotic therapy: Initiate empirical antibiotic treatment with vancomycin before blood culture results are available in patients with suspected catheter-related bloodstream infection. B Initiate empirical anti-Gram-negative bacilli antibiotics (fourth-generation cephalosporins, carbapenem or -lactam/ -lactamase inhibitor combinations with or without an aminoglycoside) in patients with severe symptoms. B Duration of treatment: complete 10-14 days of treatment after resolution of signs of infection in most patients with CVCI. B Show 2 more Antibiotic lock therapy: consider antibiotic lock therapy to prevent and treat CVCIs. If used for treatment, no signs of exit site or tunnel infection should exist. C 3. Therapeutic procedures Catheter insertion technique: As per ESMO 2015 guidelines, use strict sterile precautions when performing insertion of an implantable venous access device, in the operating room. B https://web.pathway.md/diseases/rec5xK7V7Q8Acmy3K 2/4 6/29/23, 3:47 AM Central venous catheter infection Pathway Show 4 more As per ASCO 2013 guidelines, insufficient evidence to recommend one type of central venous catheter routinely for all patients with cancer. Select a catheter type on the basis of expected duration of use, chemotherapy regimens, and patient ability to provide care. Use the minimum number of lumens essential for the management of the patient. Show 2 more 4. Specific circumstances Coagulase-negative Staphylococcus catheter infection: Diagnose CVCI on the basis of more than one set of positive blood cultures, preferentially with a culture from both the catheter and a peripheral vein. B Attempt to salvage the catheter with systemic antibiotic therapy for 10-14 days, if there are no complications. B Staphylococcus aureus catheter infection: remove catheter and implement antibiotic systemic therapy in cases of S. aureus infection. B Enterococcus catheter infection: consider retaining the catheter and implementing systemic antibiotic therapy in cases of enterococcal infection. C Gram-negative bacilli catheter infection: administer systemic antibiotics for the treatment of CVCI. B Fungal catheter infection: Remove the central venous catheter in patients in whom fungal infection is present. B Initiate anti-fungal therapy in patients in whom fungal infection is present. B 5. Preventative measures Primary prevention: As per ESMO 2015 guidelines, educate and train healthcare personnel who insert and maintain catheters. A As per ASCO 2013 guidelines, use antimicrobial/antiseptic-impregnated or coated central venous catheters and/or heparin impregnated catheters to decrease risk of catheter-related infections for short-term central venous catheters, particularly in high-risk groups such as BMT recipients or patients with leukemia; however, carefully consider the relative benefit and increased cost before they are routinely used. Clinical findings Symptoms Past medical history Chills Cancer https://web.pathway.md/diseases/rec5xK7V7Q8Acmy3K 3/4 6/29/23, 3:47 AM Central venous catheter infection Pathway Fever Diabetes mellitus Infection Human immunodeficiency virus infection Pain Immunocompromising condition Swelling Inflammation Lab findings Leukemia CRP Hematological findings ESR WBC count References 1. Schiffer CA, Mangu PB, Wade JC et al. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2013 Apr 1;31 10 1357 70. Open 2. Sousa B, Furlanetto J, Hutka M et al. Central venous access in oncology: ESMO Clinical Practice Guidelines. Ann Oncol. 2015 Sep;26 Suppl 5:v152 68. Open 3. Gahlot R, Nigam C, Kumar V et al. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci. 2014 Apr;4 2 162 7. Open 4. Rupp ME, Karnatak R. Intravascular Catheter-Related Bloodstream Infections. Infect Dis Clin North Am. 2018 Dec;32 4 765 787. Open 5. Parreco JP, Hidalgo AE, Badilla AD et al. Predicting central line-associated bloodstream infections and mortality using supervised machine learning. J Crit Care. 2018 Jun;45 156 162. Open 6. Nasia Safdar, John C O'Horo, Aiman Ghufran et al. Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis. Crit Care Med. 2014 Jul;42 7 1703 13. Open 7. Niccol Buetti, Jonas Marschall, Marci Drees et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022 Apr 19;1 17. Open https://web.pathway.md/diseases/rec5xK7V7Q8Acmy3K 4/4