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Updated: Aug 10, 2026
A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Clinical management of catheter-related infections
G Fätkenheuer1, O Cornely, H Seifert
1Department of Internal Medicine, University of Cologne, Germany Department of Microbiology, Hygiene and Medical Immunology, University of Cologne, Germany. g.fatkenheuer@uni-koeln.de
Insights
Central venous catheter infections are common and linked to significant illness. Prompt diagnosis and appropriate treatment, including catheter removal or salvage, are crucial for managing these serious bloodstream infections.
Area of Science:
- Infectious Diseases
- Medical Microbiology
- Clinical Medicine
Background:
- Central venous catheters (CVCs) are a primary source of nosocomial bloodstream infections (BSI), leading to substantial patient morbidity.
- The exact contribution of CVC-related infections (CRIs) to mortality remains unclear.
- Gram-positive organisms, particularly coagulase-negative staphylococci, are the predominant pathogens in CRIs.
Purpose of the Study:
- To review the diagnosis and management strategies for CVC-related infections.
- To highlight the importance of timely and appropriate interventions to reduce morbidity and mortality.
- To discuss the evolving diagnostic techniques and therapeutic options for CRIs.
Main Methods:
- Review of current literature on CVC-related infections.
- Analysis of diagnostic methods, including differential time to positivity.
- Evaluation of treatment strategies, encompassing catheter removal, salvage, and antibiotic therapy.
Main Results:
- Definitive diagnosis of CRI often requires catheter removal, but differential time to positivity may allow diagnosis with the catheter in situ.
- Catheter salvage is a viable option for specific infections, such as coagulase-negative staphylococci in implanted catheters.
- Immediate catheter removal is essential for Staphylococcus aureus and Candida spp. CRIs due to high risks of metastatic infection and mortality.
Conclusions:
- Effective management of CRIs involves accurate diagnosis and tailored treatment strategies.
- Antibiotic therapy, guided by susceptibility testing, is fundamental for all CRIs.
- Adjunctive therapies like antibiotic lock therapy may be beneficial in specific scenarios, particularly for catheter salvage in long-term implanted devices.
Abstract:
Central venous catheters represent a major source of nosocomial bloodstream infections, which cause considerable excess morbidity. It is currently unknown to what extent these infections contribute to mortality. Most catheter-related infections (CRIs) are caused by Gram-positive organisms (mainly coagulase-negative staphylococci). Definite diagnosis of CRI necessitates removal of the catheter in most cases. However, the recently described technique of differential time to positivity may allow diagnosis of CRI with the catheter left in place. Removal of the catheter has been standard clinical practice for the management of CRI in the past and is still recommended in many cases. In specific situations, such as infections of implanted catheters with coagulase-negative staphylococci, a trial of catheter salvage may be justified. In catheter-related bloodstream infection Staphylococcus aureus and Candida spp., the catheter should be removed immediately, due to the high risk of metastatic infection and increased mortality. A clinical work-up for the detection of additional foci (including transesophageal echocardiography in S. aureus infections) is advisable in these cases. All CRIs should be treated with antibiotics to which the causative agent has been shown to be susceptible. In addition to systemic antimicrobial therapy, antibiotic lock therapy may be applied, especially in patients with implanted long-term catheters if catheter salvage is attempted.
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