Abstract:
Background: When bloodstream infection (BSI) occurs in patients with a central venous catheter (CVC), the catheter may be the original source (catheter-related, CR) or may become a source for persistent infection. BSI should prompt an evaluation of CVC necessity, but there are challenges associated with CVC replacement.
Methods: An online multinational survey was sent to professional societies of specialties involved in treating patients who have BSI and a CVC. Clinicians were asked to choose retention versus replacement for scenarios involving different CVC types, infection sources, and pathogens. Additional questions explored central venous catheter-related bloodstream infection (CRBSI) diagnosis, management, and willingness to enrol patients in a randomized controlled trial (RCT).
Results: A total of 220 physicians responded. For peripherally inserted central catheter-related BSI, most favoured CVC replacement, although there was variability across pathogens (Candida spp 100%, Staphlococcus aureus 99%; Pseudomonas aeruginosa 94%; Enterococcus spp 75%; Enterobacterales 66%; coagulase-negative staphylococci 58%). For tunnelled CVC-related BSI, replacement recommendations also varied (Candida 99%; S. aureus 95%; P. aeruginosa 87%; Enterococcus spp 58%; Enterobacterales 44%; coagulase-negative staphylococci 33%). For catheter-unrelated BSI, there was a lower tendency to replace the CVC. For each combination of pathogen and CVC type, a majority (>50%) of participants reported willingness to enrol patients into an RCT comparing CVC replacement versus retention; the only exceptions below 50% were S. aureus (44%) and Candida spp (44%) CRBSIs from short-term non-tunnelled CVCs.
Conclusion: There is heterogeneity in CVC management practices and stated equipoise for an RCT comparing management approaches for a range of CVC types, BSI sources, and pathogens.
Reference:Buskandar F, Fowler RA, Johnstone J, Lee TC, MacFadden DR, McDonald EG, Oliver MJ, Ong SWX, Paterson D, Pinto R, Rishu A, Rogers B, Yahav D, Daneman N. Clinician survey for the management of central venous catheter-related bloodstream infection: Catheter retention versus replacement. J Assoc Med Microbiol Infect Dis Can. 2025 Jul 17;10(3):219-227. doi: 10.3138/jammi-2024-0037. PMID: 41311613; PMCID: PMC12656720.