What is the difference between Central Line-Associated Bloodstream Infection (CLABSI) and Peripherally Inserted Central Catheter (PICC) line colonization?

From the Guidelines

Central Line-Associated Bloodstream Infection (CLABSI) is a serious infection that requires immediate treatment with appropriate antibiotics and often necessitates line removal, whereas PICC line colonization refers to the presence of microorganisms on the catheter surface without causing systemic infection or symptoms. The distinction between CLABSI and PICC line colonization is crucial for appropriate management, as treating colonization unnecessarily with antibiotics contributes to antimicrobial resistance, while failing to recognize CLABSI can lead to serious complications including sepsis and death 1. CLABSI is typically diagnosed by blood cultures obtained in parallel from the central line and from a peripheral site, with a shorter time to positivity or a higher bacterial load on quantitative blood cultures from the central source suggesting a central line–associated bloodstream infection 1. Prevention strategies for both CLABSI and PICC line colonization include strict aseptic technique during insertion, chlorhexidine skin preparation, maximum barrier precautions, daily assessment of line necessity, and proper maintenance with sterile dressing changes every 7 days or when soiled 1. Some key points to consider in the management of CLABSI and PICC line colonization include:

• The use of vancomycin as an appropriate antimicrobial to use empirically until identification and antimicrobial sensitivities are available 1
• The consideration of catheter removal in cases of CLABSI, especially for infections caused by S. aureus, P. aeruginosa, fungi, or mycobacteria 1
• The importance of proper education and specific training of the staff, an adequate hand washing policy, and proper choices of the type of device and the site of insertion to reduce the risk of infection 1
• The use of ultrasound-guided venepuncture for access to all central veins and the ideal position of the catheter tip between the lower third of the superior cava vein and the upper third of the right atrium 1. Overall, the management of CLABSI and PICC line colonization requires a multidisciplinary approach and adherence to evidence-based guidelines to reduce the risk of infection and improve patient outcomes 1.

From the Research

CLABSI vs PICC Line Colonization

• CLABSI (Central Line-Associated Bloodstream Infections) and PICC (Peripherally Inserted Central Catheters) line colonization are significant concerns in healthcare settings 2, 3, 4, 5, 6
• Studies have shown that the risk of CLABSI is high worldwide, with mechanisms of catheter infection including contamination by skin bacteria, hand contamination, and hematogenous diffusion 2
• The use of antimicrobial lock therapy (ALT) has been shown to be effective in reducing CLABSI rates, with molecules such as daptomycin and tigecycline being promising options 2
• Ethanol-lock therapy (ELT) has also been shown to be effective in reducing CLABSI rates, with a study demonstrating a significant reduction in CLABSI rates in patients treated with 70% ELT 3
• Taurolidine-citrate lock solution (TCS) has been shown to be effective in reducing CLABSI rates in pediatric patients, with a study demonstrating an 80% reduction in CLABSI rates in patients treated with TCS 4
• Educational interventions have also been shown to be effective in reducing CLABSI rates, with a systematic review demonstrating a significant reduction in CLABSI rates in adult intensive care units following educational interventions 5
• A comparison of PICCs and central venous catheters (CVCs) found that PICCs were associated with a lower risk of CLABSI than CVCs, although the risk of CLABSI was similar in hospitalized patients 6
• The incidence of CLABSI per 1000 catheter-days was found to be lower in patients with PICCs compared to CVCs, although the incidence rate ratio was similar between the two groups 6

Comparison of CLABSI Rates

• A study comparing CLABSI rates between PICCs and CVCs found that PICCs were associated with a lower risk of CLABSI (relative risk 0.62,95% confidence interval 0.40-0.94) 6
• However, the incidence rate ratio of CLABSI per catheter-day was similar between PICCs and CVCs (incidence rate ratio 0.91,95% confidence interval 0.46-1.79) 6
• The use of TCS was found to reduce CLABSI rates by 80% in pediatric patients, with a significant reduction in CLABSI rates per 1000 catheter-days (from 14.44 to 2.45, P < 0.001) 4

Prevention and Treatment of CLABSI

• The use of ALT, ELT, and TCS has been shown to be effective in reducing CLABSI rates 2, 3, 4
• Educational interventions have also been shown to be effective in reducing CLABSI rates 5
• The choice of catheter type (PICC or CVC) should be based on individual patient needs and risk factors, with consideration of the potential risks and benefits of each type 6