What is the treatment for Catheter-Related Bloodstream Infection (CRBSI) caused by Corynebacterium?

Treatment of Catheter-Related Bloodstream Infection (CRBSI) Caused by Corynebacterium

For Corynebacterium CRBSI, catheter removal is indicated for short-term catheters, and also for long-term catheters unless there are absolutely no alternative vascular access sites available. 1

Diagnostic Confirmation

Before initiating treatment, confirm true bacteremia rather than contamination:

• At least 2 positive blood cultures from different sites are required to diagnose CRBSI due to Corynebacterium species, as single positive cultures may represent contamination 1
• Obtain blood samples from both the catheter and a peripheral vein 1

Catheter Management Algorithm

For Short-Term Catheters:

• Remove the catheter immediately 1
• This is a firm recommendation with no exceptions for short-term central venous catheters 1

For Long-Term Catheters or Implanted Ports:

• Remove the catheter unless there are no alternative intravascular access sites 1
• Corynebacterium species are classified among "less virulent microbes that are difficult to eradicate" alongside Bacillus and Micrococcus species 1
• Catheter salvage may be attempted only when vascular access is critically limited (e.g., patients on hemodialysis or with short-gut syndrome requiring long-term parenteral nutrition) 1

Antibiotic Selection

Empirical Therapy:

• Start vancomycin empirically while awaiting susceptibility results, as it provides reliable coverage for Corynebacterium species 1
• Vancomycin dosing: 15-20 mg/kg IV every 8-12 hours, adjusted for renal function 2

Definitive Therapy Based on Susceptibility:

• Consider switching to non-glycopeptide antibiotics (such as linezolid, rifampin, or tetracycline) once susceptibilities are available, as this may lead to faster fever resolution, particularly if the catheter is retained 3
• Corynebacterium species typically show: 100% susceptibility to vancomycin, 98% to linezolid, 84% to rifampin, and 81% to tetracycline 3

Duration of Antibiotic Therapy

With Catheter Removal:

• 7 days of systemic antibiotic therapy is adequate for uncomplicated Corynebacterium CRBSI after catheter removal 3
• This shorter duration has been shown effective for resolution of infection 3

With Catheter Retention (Salvage Attempt):

• 10-14 days of systemic therapy plus antimicrobial lock therapy is recommended 1
• Antibiotic lock therapy involves instilling high concentrations of antibiotics into the catheter lumen 4

Extended Therapy Indications:

• 4-6 weeks of therapy if bacteremia persists >72 hours after catheter removal despite appropriate antibiotics 1
• 4-6 weeks of therapy for complicated infections including endocarditis or suppurative thrombophlebitis 1

Monitoring and Follow-Up

• Obtain repeat blood cultures 72 hours after initiating therapy to document clearance 1
• If blood cultures remain positive at 72 hours despite appropriate therapy, remove the catheter (if still in place) and extend treatment duration 1
• Suspect suppurative thrombophlebitis if bacteremia persists beyond 3 days of adequate antimicrobial therapy, and obtain imaging (CT or ultrasound) to evaluate for thrombus 1

Critical Pitfalls to Avoid

• Do not treat based on a single positive blood culture - this may represent contamination rather than true infection 1
• Do not retain short-term catheters - removal is mandatory regardless of clinical stability 1
• Do not use catheter salvage routinely for long-term catheters - this should be reserved only for patients with no alternative vascular access 1
• Do not continue the same management if bacteremia persists at 72 hours - this indicates treatment failure requiring catheter removal and evaluation for metastatic infection 1