What are the oral options for Central Line-Associated Bloodstream Infection (CLABSI) treatment or prevention?

From the Guidelines

Oral options for Central Line-Associated Bloodstream Infections (CLABSIs) are limited, but include fluoroquinolones, trimethoprim-sulfamethoxazole, linezolid, and doxycycline.

• Fluoroquinolones such as ciprofloxacin (500-750 mg every 12 hours) or levofloxacin (500-750 mg every 24 hours) for 7-14 days can be used to treat CLABSIs, especially in cases where the causative organism is susceptible to these agents 1.
• Trimethoprim-sulfamethoxazole (160/800 mg every 12 hours) for 7-14 days is another option for the treatment of CLABSIs, particularly in cases where the organism is susceptible to this combination 1.
• In cases where methicillin-resistant Staphylococcus aureus (MRSA) is suspected, oral options such as linezolid (600 mg every 12 hours) or doxycycline (100 mg every 12 hours) may be considered for 7-14 days, as suggested by 1.
• The choice of oral antibiotic should be guided by the results of blood cultures and susceptibility testing, as emphasized in 1.
• It is essential to note that the use of oral antibiotics for CLABSIs should be individualized based on the specific clinical circumstances, including the severity of the infection, the presence of any underlying medical conditions, and the results of microbiological testing 1.
• Additionally, the use of antibiotic lock therapy, which involves installing a high concentration of an antibiotic in the catheter lumen, may be considered in conjunction with systemic antibiotic therapy, as discussed in 1.

From the Research

Oral Options for CLABSI Treatment or Prevention

There are no specific oral options mentioned in the provided studies for the treatment or prevention of Central Line-Associated Bloodstream Infections (CLABSI).

General Prevention Strategies

• The Centers for Disease Control and Prevention guidelines and checklist bundle are intended to provide evidence-based recommendations for the prevention of CLABSIs 2.
• Adherence to the central line bundle recommendations is crucial for the prevention of CLABSI, but gaps in adherence have been identified 2.
• Electronic health record solutions can help reduce CLABSIs by enhancing documentation of central line insertion practices, line days, and daily line necessity 3.
• Nurse-driven interventions, such as educational modules for CLABSI prevention and CVC-specific logbooks, can significantly reduce the incidence of CLABSIs 4.
• Evidence-based practices, including the CLABSI bundle and central line maintenance bundles, have demonstrated their effectiveness in reducing CLABSI 5.

Key Findings

• CLABSI patients have longer catheter and hospitalization durations and higher mortality risk 6.
• Resistant microorganism CLABSIs are associated with elevated mortality risk 6.
• Identification of CVCs increased by 35%, resulting in a decrease in CLABSI rates, when an integrated electronic health record solution was implemented 3.
• The incidence of CVC-related infections decreased by 40% between the first and second three-year study period when nurse-led changes in CVC management were implemented 4.