Treatment of Infection of the Vascular Access – Central Vein Catheters

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia
2000

a) Presentation with tunnel infection or bacteraemia/septicaemia will require removal of the central line after 48-72 hrs of antibiotics and being afebrile (Level C)
b) Positive blood cultures for S aureus: 2 weeks IV antibiotics or on the advice of the microbiologist (Level B)
c) Avoid vancomycin empirically unless in recognized MRSA or in MRSA carriers (Level B)
d) When exit-site and tunnel not infected, catheter replacement over guidewire under antibiotic (Level B)

Dialysis Guidelines. Vascular access
20. Managing infection in haemodialysis catheters

CSN-Canada
2006

- Treat central venous catheter-related bacteremia with systemic antibiotics and catheter exchange over a wire. (Grade D)
- Treat catheter tunnel infections without bacteremia with parenteral antibiotics and appropriate local measures. Catheter removal is indicated if the infection fails to respond to 2 wk of therapy. (Grade D)

Guideline Chapter 4 – Managing VA Complications
PDF: Pg 20 of 27

EBPG-Europe
November 2002

- Non-tunneled short-term catheter should be removed and cultured (Level C)
- Tunneled catheters should be treated for 2-4 weeks (4 wks for bactaeremia) (Level C)
- Catheters to be removed with tunnel infection or infection for > 36 h
- If catheter not removed despite bactaeremia, 2 weeks antibiotic lock after each dialysis in conjunction with parenteral therapy (Level C)
VI.4.4.
- Two separate blood cultures before start antibiotics for all access related infection (Level B)
- Methicillin first choice Glycopeptide recommended in hospitals and countries with increased incidence of MRSA and in known MRSA carriers (Level A)
- Additional coverage for gram-negatives including pseudomonas with third or fourth generation cephalosporins in severely ill and immunocompromised patients (Level B)

VI.4 Treatment of vascular access infection

KDOQI-US
2006

7.4 Treatment of an infected HD catheter or port should be based on the type and extent of infection.

• 7.4.1 All catheter-related infections, except for catheter exit-site infections, should be addressed by initiating parenteral treatment with an antibiotic(s) appropriate for the organism(s) suspected. (A)
• 7.4.2 Definitive antibiotic therapy should be based on the organism(s) isolated. (A)
• 7.4.3 Catheters should be exchanged as soon as possible and within 72 hours of initiating antibiotic therapy in most instances, and such exchange does not require a negative blood culture result before the exchange. (B) Follow-up cultures are needed 1 week after cessation of antibiotic therapy (standard practice).
• 7.4.4 Port pocket infections should be treated with systemic antibiotics and irrigation, in conjunction with the manufacturers' recommendations. (B)

Vascular Access: 7.4 Treatment and Prevention of CV and Port Complications

UK-Guidelines
2007

- Peripheral and central line blood cultures should be taken prior to starting antibiotics in all cases of suspected catheter-related infection.

Module 3a: Haemodialysis- 7.0 Vascular Access