The management of central intravenous catheter infections

Catheter-associated infection is a frequent complication in patients with indwelling intravenous catheters used for administration of total parenteral nutrition and/or cancer chemotherapy. Thirty-seven catheter-associated infections in 19 patients were identified in our retrospective survey conducted for the period from January 1, 1982, through December 31, 1982. Fourteen patients were receiving total parenteral nutrition for gastrointestinal disorders, and five were receiving total parenteral nutrition and chemotherapy for underlying malignancy. Coagulase-negative staphylococci were isolated from 65% of catheter-associated bacteremias, as a single species (18 cases) or as one of multiple species (6 cases). Ten of 33 coagulase-negative staphylococcal isolates (30%) were methicillin-resistant. Twenty-one infections (57%) were initially treated with antibiotics administered through the central venous catheter. There were three failures with this treatment; in two cases the catheter was removed because of continued fever and positive blood cultures despite antibiotics, and one patient developed a pyogenic granuloma. The remaining 18 (86%) catheter-associated infections were cured without catheter removal. However, a new infection occurred subsequently in two of these patients. We recommend that vancomycin and an aminoglycoside be the initial empiric therapy for suspected catheter-associated sepsis. Lack of defervescence or continued positive blood cultures for 2 to 4 days despite antibiotics are indications for catheter removal. Otherwise antibiotics should be continued for 14 to 21 days.