Central line-associated bloodstream infection
Central line-associated bloodstream infection (CLABSI) is bacteremia or fungemia in a patient with a central venous catheter that is not explained by infection at another site, confirmed by a matching catheter-tip culture or differential quantitative blood cultures. First-line treatment is prompt catheter removal plus empiric vancomycin with gram-negative coverage, narrowed to a pathogen-directed course of 7 to 14 days, or at least 4 weeks for Staphylococcus aureus.
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What this article covers
- Overview
Definition: Central line-associated bloodstream infection (CLABSI) is bacteremia or fungemia in a patient with a central venous catheter (CVC) that is not explained by infection at another site.
- Epidemiology
Device burden: A CVC is present in about 55% of intensive care unit (ICU) patients and 24% of non-ICU inpatients, and each catheter-day adds risk.
- Risk factors
Prolonged catheterization: The strongest modifiable risk factor, increasing CLABSI risk 3.4-fold; daily review of ongoing need is the counter-strategy.
- Pathophysiology
Biofilm formation: Skin organisms migrate along the extraluminal catheter surface within days of insertion, while hub contamination seeds the intraluminal surface of longer-dwelling catheters; the…
- Clinical features
Onset: Fever and chills typically develop while the catheter is in place or within hours of catheter manipulation, sometimes abruptly with rigors during flushing.
- Differential diagnosis
Catheter-associated urinary tract infection (CAUTI): Fever in a device-bearing patient, but the urine culture grows at least 10^3 colony-forming units/mL with pyuria, and blood cultures are negative for the same organism.
- Diagnosis
What establishes the diagnosis: CLABSI is confirmed when the same organism grows from both the catheter tip and at least one percutaneous blood culture, or when paired quantitative cultures show a…
- Management
First, obtain blood cultures and start empiric therapy immediately, stabilizing any patient with septic shock using intravenous fluids and vasopressor support: Vancomycin 15-20 mg/kg IV every 8-12…
- Complications
Septic shock: Can develop within hours of organism entry, especially with gram-negative bacilli or Staphylococcus aureus, and defines the need for immediate stabilization.
- Prognosis
Clearance time: Median time to clearance of MRSA bacteremia is 7 to 9 days with appropriate therapy and source control.
- Prevention
Insertion bundle: Hand hygiene, chlorhexidine skin antisepsis, and maximal sterile barrier precautions (mask, cap, gown, sterile gloves, large sterile drape) for every CVC placement.
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