Suspected catheter-related bloodstream infection - Management Algorithm • Temperature 37.8 C • Rigors •Tunnel or exit site purulence Obtain blood cultures from the catheter lumen and the dialysis circuit and start empiric antibiotics Antibiotic Management - Uncomplicated CRBSI • Responds quickly to empiric antibiotics • No evidence of metastatic infection • Hemodynamically stable Antibiotic Management - Complicated CRBSI - 6-8 weeks of tailored systemic antibiotics • Hemodynamic instability • Persistent fever and/or bacteremia despite appropriate antibiotic therapy • Evidence of metastatic infection (endocarditis, epidural abscess, osteomyelitis, septic arthritis) Keep catheter if -Presentation is consistent with uncomplicated CRBSI: • Rapid improvement after empiric antibiotics • No hemodynamic stability • No evidence of metastatic infection Remove catheter if - Presentation is consistent with complicated CRBSI: • Severe sepsis • Hemodynamic instability • Evidence of tunnel or exit site infection • Persistent fever and/or bacteremia 48-72 hours after starting tailored antibiotics • Resistant pathogens (S. aureus, fungal or multidrug resistant organisms) Exchange catheter if - Presentation is consistent with complicated CRBSI but patient has limited vascular access options and is: • Afebrile 48-72 hours after starting tailored antibiotics • Hernodynamically stable after treatment initiation • No evidence of tunnel or exit site infection #catheter #bloodstream #infection #Management #Algorithm #CRBSI #diagnosis #management
