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

Treatment of CRBSI Caused by Staphylococcus haemolyticus

For catheter-related bloodstream infection (CRBSI) caused by Staphylococcus haemolyticus, initiate empirical vancomycin therapy and remove short-term catheters immediately; for long-term catheters, attempt salvage with systemic antibiotics plus antibiotic lock therapy for 10-14 days, but remove the catheter if fever or bacteremia persists beyond 72 hours. 1

Empirical Antibiotic Therapy

• Start empirical therapy with vancomycin to cover coagulase-negative staphylococci (including S. haemolyticus), which are the most common pathogens in CRBSI 1
• Add gram-negative coverage (third-generation cephalosporin, carbapenem, or β-lactam/β-lactamase combination) based on local antibiogram until culture results are available 1
• Important caveat: S. haemolyticus can develop vancomycin resistance, particularly with prolonged vancomycin exposure, so monitor clinical response closely and obtain susceptibility testing 2
• If vancomycin MIC is >1 mg/mL or clinical failure occurs, consider alternative agents such as daptomycin or linezolid 1

Catheter Management Strategy

For Short-Term (Non-Tunneled) Catheters:

• Remove the catheter immediately and insert a new catheter at a different site 1
• Treat with systemic antibiotics for 5-7 days after catheter removal if uncomplicated 3, 4

For Long-Term (Tunneled) Catheters or Ports:

• Attempt catheter salvage if the patient has limited venous access, no tunnel/exit site infection, and no signs of severe sepsis 1
• Use systemic antibiotics PLUS antibiotic lock therapy for 10-14 days 1, 3
• Antibiotic lock should be instilled after each dialysis session (for hemodialysis catheters) or renewed every 24-48 hours for other long-term catheters 1
• Remove the catheter if any of the following occur:
  • Persistent fever or bacteremia >72 hours despite appropriate antibiotics 1, 3
  • Clinical deterioration or hemodynamic instability 1
  • Evidence of metastatic infection (endocarditis, suppurative thrombophlebitis, osteomyelitis) 1, 3
  • Tunnel or exit site infection 1

Duration of Antibiotic Therapy

• Uncomplicated CRBSI with catheter removal: 5-7 days of systemic antibiotics 3, 4
• Uncomplicated CRBSI with catheter retention: 10-14 days of systemic antibiotics plus antibiotic lock therapy 1, 3
• Persistent bacteremia >72 hours after catheter removal: Extend therapy to 4-6 weeks 1, 3
• Complicated infections (endocarditis, suppurative thrombophlebitis, osteomyelitis): 4-6 weeks of parenteral therapy 1, 3

Antibiotic Lock Therapy Details

• Combine the antibiotic (vancomycin or daptomycin) with heparin and instill into each catheter lumen 1, 5
• Success rates for coagulase-negative staphylococci (including S. haemolyticus) with antibiotic lock therapy range from 75-85% 1, 5
• Daptomycin lock therapy has demonstrated 85% cure rate for coagulase-negative staphylococcal CRBSI in clinical studies 5
• Never use antibiotic lock therapy alone—it must be combined with systemic antibiotics 1

Monitoring and Follow-Up

• Obtain repeat blood cultures 72 hours after initiating therapy to document clearance 3, 6
• If blood cultures remain positive at 72 hours, this indicates treatment failure and mandates catheter removal 1, 3
• Assess for clinical improvement (defervescence, resolution of hemodynamic instability) within 48-72 hours 1, 3
• Consider surveillance blood cultures 1 week after completing therapy if the catheter was retained 3

Special Considerations for Hemodialysis Catheters

• For hemodialysis patients with S. haemolyticus CRBSI, guidewire exchange is an acceptable alternative to immediate removal if symptoms resolve within 2-3 days and there is no metastatic infection 1
• Use validated dosing schedules for vancomycin to ensure therapeutic concentrations in dialysis patients 1
• Antibiotic lock solution can be renewed after each dialysis session 1

Common Pitfalls to Avoid

• Do not treat with antibiotics alone without addressing the catheter—this leads to recurrence in the majority of cases 1
• Do not delay catheter removal if bacteremia persists >72 hours, as this increases risk of metastatic complications and mortality 1
• Do not assume all coagulase-negative staphylococci are equally virulent—while S. haemolyticus is generally less virulent than S. aureus, it can still cause serious complications if inadequately treated 4
• Be aware of vancomycin resistance potential in S. haemolyticus, particularly with prolonged vancomycin exposure 2