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Treatment of IV catheter-associated infections Guidelines for 2001 based on anecdotes, wisdom or facts



Treatment of IV catheter-associated infections Guidelines for 2001 based on anecdotes, wisdom or facts



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 41: 503



Guidelines for management of intravascular catheter-related infections were recently published. There were scant data and few prospective studies to guide the authors. Recommendations with good supportive evidence: For coag-neg. staph CRBSI - tx empirically w/vancomycin, change to semi-synthetic PCN if susceptible; for treatment failure (persistent fever/positive blood cultures, or relapse after antibiotics d/c'd) remove catheter. For S. aureus CRBSI - remove catheter; use beta-lactam antibiotics when isolate susceptible; w/PCN allergy w/o anaphylaxis/angioedema, 1st generation cephalosporins can be used; w/serious beta-lactam allergy or MRSA, use vancomycin. For GNR CRBSI - w/non-aeruginosa pseudomonads, B. cepacia, Stenotrophomonas, Agrobacterium, and Acinetobacter, seriously consider catheter removal. For misc. CRBSI - w/Bacillus or Corynebacteria, remove catheter; w/mycobacteria (eg M. fortuitum) remove the catheter. For Candida CRBSI - remove catheter; use systemic therapy for all patients; ampho-B recommended for suspected catheter-related candidemia if hemodynamically unstable or if has received prolonged fluconazole; use fluconazole if hemodynamically stable and no recent fluconazole use, or if fluconazole susceptible isolate; tx for 14 d. after last positive blood culture and symptoms of infection resolved; use ampho-B for C. krusei; remove tunneled/implanted catheters w/documented catheter-related fungemia. For septic thrombosis - remove catheter; surgical excision/repair is needed w/peripheral arterial pseudoaneurysms; anticoagulate for great central vein septic thrombosis; when due to Candida, use prolonged ampho-B or fluconazole if susceptible. For persistent bloodstream infection and endocarditis - remove involved catheter; for empiric therapy include staphylococcal coverage; with rare exception, Candida endocarditis requires surgery.

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