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Catheter related bloodstream infection — Clinical Guidelines

Overview

Catheter-related bloodstream infections (CRBSI) are significant hospital-acquired infections associated with morbidity, mortality, and increased healthcare costs, particularly in immunocompromised and critically ill patients 1 6 7.

Diagnosis

Clinical Presentation: Fever, chills, hypotension, and signs of sepsis 1 6.

Laboratory Tests: Blood cultures positive for pathogens, elevated white blood cell count 1 6.

Catheter-Related Criteria: Positive semiquantitative culture from catheter tip compared to peripheral blood, or clinical suspicion supported by imaging or other diagnostic tests 6.

Management

Antibiotic Therapy: Empiric broad-spectrum antibiotics tailored to culture and sensitivity results 6.

Catheter Removal: Removal of the infected catheter is often necessary 6.

Supportive Care: Fluid resuscitation, vasopressors if needed, and management of underlying conditions 6.

Source Control: Addressing any underlying source of infection 6.

Special Populations

Immunocompromised Patients: Higher risk for opportunistic pathogens like Brevibacterium casei 1.

Geriatric Patients: Increased incidence in elderly ICU patients, with higher mortality rates 10.

Key Recommendations

Empiric Broad-Spectrum Antibiotics: Initiate promptly based on clinical suspicion and local resistance patterns (Evidence: Strong 6).

Remove Infected Catheter: Prompt removal of the infected catheter to reduce morbidity and mortality (Evidence: Strong 6).

Implement Prophylactic Measures: Use of securement devices and proper catheter care to prevent CRBSI (Evidence: Moderate 15).

Enhance Procedural Competence: Simulation-based training for central venous catheter insertion to reduce infection rates (Evidence: Moderate 13).

Topical Decontamination: Consider use of chlorhexidine and nasal ointments to reduce CRBSI in high-risk groups like hematology patients (Evidence: Moderate 8).

References

1 Nabi A, Lone R, Alatoom A, Habous M, Mathur B, Monga R. Brevibacterium casei catheter-related bloodstream infection in an immunocompromised patient with multiorgan failure in Dubai hospital, UAE. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2026. link 2 Schrank GM, Jozefowski N, Zura RD, Jeray KJ, Gary JL, Gaski GE et al.. Local Antibiotics and the Risk of Antimicrobial Resistance in Extremity Fractures Complicated by Fracture-Related Infection. The Journal of bone and joint surgery. American volume 2025. link 3 Lafuente Cabrero E, Terradas Robledo R, Civit Cuñado A, García Sardelli D, Hidalgo López C, Giro Formatger D et al.. Risk factors of catheter- associated bloodstream infection: Systematic review and meta-analysis. PloS one 2023. link 4 Lu H, Yang Q, Tian B, Lyu Y, Zheng X, Xin X. A meta-analysis of the comparison of phlebitis between midline catheters and peripherally inserted central catheters in infusion therapy. International journal of nursing practice 2022. link 5 Tancredi TS, Kissane JL, Lynch FC, Li M, Kong L, Waybill PN. The Effect of Immediate Versus Delayed Port Access on 30-Day Infection Rate. Journal of infusion nursing : the official publication of the Infusion Nurses Society 2020. link 6 Chaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M et al.. Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). Enfermedades infecciosas y microbiologia clinica (English ed.) 2018. link 7 Chaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M et al.. Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Medicina intensiva 2018. link 8 Samuelson C, Kaur H, Kritsotakis EI, Goode SD, Nield A, Partridge D. A daily topical decontamination regimen reduces catheter-related bloodstream infections in haematology patients. The Journal of infection 2018. link 9 Morrison J, Kaufman J. Vascular Access Tracking System: a Web-Based Clinical Tracking Tool for Identifying Catheter Related Blood Stream Infections in Interventional Radiology Placed Central Venous Catheters. Journal of digital imaging 2016. link 10 Chernecky C, Macklin D, Blackburn P. Catheter-Related Bloodstream Infections (CR-BSI) in Geriatric Patients in Intensive Care Units. Critical care nursing quarterly 2015. link 11 Martin LD, Rampersad SE, Geiduschek JM, Zerr DM, Weiss GK, Martin LD. Modification of anesthesia practice reduces catheter-associated bloodstream infections: a quality improvement initiative. Paediatric anaesthesia 2013. link 12 Cohen ER, Feinglass J, Barsuk JH, Barnard C, O'Donnell A, McGaghie WC et al.. Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit. Simulation in healthcare : journal of the Society for Simulation in Healthcare 2010. link 13 Barsuk JH, Cohen ER, Feinglass J, McGaghie WC, Wayne DB. Use of simulation-based education to reduce catheter-related bloodstream infections. Archives of internal medicine 2009. link 14 Melo MN, Dugourd D, Castanho MA. Omiganan pentahydrochloride in the front line of clinical applications of antimicrobial peptides. Recent patents on anti-infective drug discovery 2006. link 15 Rosenthal K. Get a hold on costs and safety with securement devices. Nursing management 2005. link 16 Swartz RD. Exit-site and catheter care: review of important issues. Advances in peritoneal dialysis. Conference on Peritoneal Dialysis 1999. link 17 Vanek VW, Kupensky DT, Thomson DJ. Hypersensitivity-like reactions related to insertion of aquavene-based midline and PICC catheters. Journal of intravenous nursing : the official publication of the Intravenous Nurses Society 1997. link

Catheter related bloodstream infection