Do I Need to Remove that Line?

Catheter-Related Infection Diagnosis and Management: Summary of IDSA Guidelines

by A. M. Akhter (MS3, UT Southwestern Medical School)

Background:

  • Familiarity with CRBSI guidelines is essential as scenarios like new onset of fever in an ICU patient with a catheter is a near daily challenge encountered by physicians
  • More than 250,000 central-line associated bloodstream infections occur each year
  • In addition to increasing mortality (risk estimated to be 12-25%), such infections independently increase hospital cost and length of stay
  • The extra costs of treating healthcare-associated infections are no longer being reimbursed by CMS
  • Hospitals are mandated to report rates of CRBSI; starting in October 2014 hospitals with high rates of CRBSIs will lose 1% of every Medicare payment for a year
  • Risk of infection is multifactorial, influenced by host factors, treatment setting (hospital ward, ICU, etc.), type of catheter, duration of use, conditions during placement, etc.
  • Definitive diagnosis of a CRBSI requires specific evidence from a set of blood cultures
  • Catheter removal may be beneficial, but should not be a routine practice as most catheters removed from patients with suspected CRBSIs were sterile
  • IDSA guidelines provide straightforward advice for empiric therapy as well as management of serious complications, notably septic thrombophlebitis and infective endocarditis

IDSA Guidelines summary

IDSA Guidelines summary2

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