What are the treatments for Central Line-Associated Bloodstream Infections (CLABSIs)?

From the Guidelines

Central Line-Associated Bloodstream Infections (CLABSIs) are typically treated with empiric antibiotic therapy, which should be started immediately when there are clinical signs of infection, without waiting for blood culture results to be available 1.

Treatment Options

• Vancomycin is the recommended treatment for CLABSIs, especially when the most frequent infectious agents are Staphylococcus coagulase-negative and S. aureus methicillin-resistant (MRSA) 1.
• Daptomycin can be used in cases of higher risk for nephrotoxicity or in high prevalence of MRSA strains, with vancomycin minimum inhibitory concentration (MIC) ≥2 μg/ml 1.
• Anti-Gram-negative bacilli antibiotics, such as fourth-generation cephalosporins, carbapenem or β-lactam/β-lactamase combinations with or without an aminoglycoside, are recommended for empirical use in cases that present with severe symptoms (sepsis, neutropenia) 1.
• Echinocandins (caspofungin, micafungin, anidulafungin) are recommended for the empirical treatment of candidaemia in critically ill patients, especially if one of the following risk factors is present: haematological malignancy, a recent bone marrow transplant or a solid organ transplant, presence of femoral catheters, colonisation of Candida spp. at multiple sites or prolonged use of broad spectrum antibiotics 1.

Catheter Management

• Catheter removal is recommended in cases of clinical deterioration or persisting or relapsing bacteremia, presence of suppurative complications or for particular agents 1.
• Antibiotic lock therapy can be used in conjunction with systemic antibiotic therapy for the treatment of adults with CRBSIs, but its use in children is not routinely recommended due to limited data 1.

Duration of Therapy

• The duration of systemic antimicrobial therapy after a CRBSI diagnosis depends on several factors, including catheter removal or retention, response to antimicrobial therapy within the first 48-72 hours, and the development of other complications 1.
• A 10-14 day course of systemic antimicrobial therapy is generally adequate for pediatric patients with CRBSIs, assuming a response to antimicrobial therapy within 48-72 hours and no evidence of complications 1.

From the Research

Treatments for Central Line-Associated Bloodstream Infections (CLABSIs)

• The provided studies do not directly address treatments for CLABSIs, but rather focus on prevention and reduction of CLABSI rates in various settings, such as intensive care units (ICUs) and neonatal intensive care units (NICUs) 2, 3, 4, 5, 6.
• However, some studies suggest that certain interventions, such as daily chlorhexidine gluconate (CHG) bathing, can help reduce CLABSIs in ICUs 5.
• Other studies emphasize the importance of staff education, standardization of skin preparation protocols, and implementation of central catheter insertion and maintenance checklists to prevent CLABSIs 3, 4.
• The use of antiseptic agents, maximal sterile barrier precautions, and revision of central catheter configuration and maintenance protocols are also mentioned as potential strategies to reduce CLABSI rates 4.
• A national initiative, "On the CUSP: Stop BSI," aimed to reduce CLABSI rates among participating adult ICUs, and resulted in a significant and sustained decrease in CLABSIs, with an overall 43% decrease 6.

Prevention Strategies

• Educational interventions, such as staff education and training, can be effective in reducing CLABSI rates in adult ICUs 3.
• Standardization of skin preparation protocols and implementation of central catheter insertion and maintenance checklists can also help prevent CLABSIs 4.
• The use of antiseptic agents, such as CHG, can help reduce CLABSIs in ICUs 5.
• Maximal sterile barrier precautions and revision of central catheter configuration and maintenance protocols can also contribute to reducing CLABSI rates 4.

Settings

• ICUs: Several studies focus on reducing CLABSI rates in ICUs, highlighting the importance of staff education, standardization of protocols, and use of antiseptic agents 3, 5, 6.
• Neonatal ICUs: One study demonstrates the effectiveness of a multidisciplinary evidence-based quality improvement collaborative in reducing CLABSI rates in a neonatal ICU 4.
• Blood and marrow transplantation population: One study reviews the literature on reducing CLABSIs in this population, suggesting the potential benefits of daily CHG bathing 5.