From the Guidelines
In a patient with an indwelling catheter and sepsis, coagulase-negative staphylococci, Staphylococcus aureus, aerobic gram-negative bacilli, and Candida albicans are the most commonly expected pathogens, with coagulase-negative staphylococci being the most prevalent 1.
Pathogen Identification
The identification of the pathogen is crucial in guiding the treatment.
- Coagulase-negative staphylococci, such as Staphylococcus epidermidis, are commonly found on the skin and can colonize the catheter, leading to infection.
- Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is also a common cause of catheter-related infections.
- Aerobic gram-negative bacilli, such as Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, can also cause catheter-related infections, especially in patients with compromised immune systems or those who have been exposed to broad-spectrum antibiotics.
- Candida albicans is a common cause of fungal catheter-related infections, especially in patients with prolonged catheter use or those who have received broad-spectrum antibiotics.
Treatment Approach
The treatment approach for catheter-related infections involves:
- Removing the catheter, if possible, to eliminate the source of infection.
- Obtaining blood and urine cultures to guide targeted therapy.
- Initiating empiric antibiotic therapy with broad-spectrum coverage, such as vancomycin, piperacillin-tazobactam, or a carbapenem, pending culture results.
- Adjusting the antibiotic regimen based on culture and susceptibility results.
- Considering catheter salvage therapy with antibiotic lock therapy in select cases where catheter removal is not feasible.
Important Considerations
- The decision to remove the catheter should be based on the severity of the infection, the type of catheter, and the patient's overall clinical condition.
- Antibiotic lock therapy may be considered as a salvage strategy in patients with limited access options and long-term intravascular access requirements.
- Routine replacement of catheters to prevent infection is not recommended, but rather, catheters should be removed or replaced as needed based on clinical judgment.
From the Research
Expected Pathogen in Sepsis with Indwelling Catheter
- The most common pathogen associated with catheter-associated urinary tract infections (CAUTIs) is Escherichia coli (E. coli) 2, 3, 4.
- E. coli is a common cause of sepsis, urinary tract infections (UTIs), pneumonia, meningitis, and pyogenic liver abscess 3.
- The presence of an indwelling urinary catheter increases the risk of severe sepsis, and E. coli is a common isolate in such cases 2.
- Other pathogens such as Klebsiella pneumoniae (K. pneumoniae) and Proteus mirabilis (P. mirabilis) can also cause UTIs, but E. coli is the most prevalent 4.
- The increasing resistance of E. coli to antibiotics, including beta-lactam antibiotics, makes it a significant concern in the treatment of CAUTIs and sepsis 3, 4.