CLABSI and Endocarditis Flashcards
CLABSI
Bacteremia or fungemia with presence of intravascular device and > 1 positive blood culture + clinical sxs of infection + no other apparent source of BSI identified
Peripheral Catheters
For short-term use (< 7 days)
Low risk of infection
Peripherally Inserted Central Catheter (PICC)
Central venous catheter
For longer term use
Moderate risk of infection
Central Line
Central venous catheter
For longer term use
High risk of infection
Most Common Cause of CLABSI
Contamination entering system at catheter/administration set junction
Most Common Pathogen Causing CLABSI
MRSA
Diagnosis of CLABSI
Obtain blood cultures before first dose of antibiotic from peripheral vein (use two different peripheral vein sites - two vials per blood draw, one aerobic and one anaerobic)
Cath tip culture
If same organism growing from peripheral blood culture and cath tip culture and no other source of BSI identified → likely device-associated bacteremia
Considerations for Empiric Therapy of CLABSI
IV therapy preferred initially
Bacteriocidal antibiotic preferred
Empiric therapy should contain broad gram-positive cocci coverage (including MRSA)
Empiric Therapy for Critically Ill Patients in ICU
In critically ill patients in ICU with femoral or other central catheter: add empiric coverage for GNR and Candida
Example: Vanco + Cefepime + Micafungin
Directed Therapy CLABSI - MRSA
Vancomycin
Directed Therapy CLABSI - MSSA
Cefazolin or Oxacillin
Directed Therapy CLABSI - Pseudomonas
Zosyn, Cefepime, Meropenem
Directed Therapy CLABSI - E. coli, Klebsiella
Beta-lactam preferred, if susceptible Ceftriaxone
Directed Therapy CLABSI - Candida (except glabrata or krusei)
Fluconazole
Directed Therapy CLABSI - Candida glabrata, krusei
Micafungin
