Bacteremia / CLABSI / Line Infection

  • CC: Fever, chills, rigors, positive blood cultures

  • PP: Persistent fever, hypotension, rigors during line use, line tenderness/erythema/drainage

  • PN: No focal urinary, pulmonary, abdominal, skin source unless present

  • pertinent SHx: IVDU, recent hospitalization, dialysis, SNF/LTAC

  • Etiology: Bloodstream infection from line, skin flora, urinary/GI/pulmonary source, or endovascular source

  • risk factors: Central line, PICC, port, HD catheter, TPN, immunosuppression, recent antibiotics, prosthetic valves/devices

  • initial DATA: CBC, CMP, lactate if septic, blood cultures x2 sets, cultures from peripheral + line if present, UA/CXR/source workup

  • pending DATA: Blood culture speciation/susceptibilities, repeat blood cultures, TTE if persistent bacteremia/S. aureus/Enterococcus/Candida

  • prior data: Prior micro, MDR history, MRSA, ESBL, VRE

  • MEDS: Recent antibiotics, immunosuppression, anticoagulation

  • COURSE:

Plan:

  • Antibiotics:

    • Stable: Vancomycin + Cefepime

    • Septic shock/MDR risk: Vancomycin + Meropenem

    • Candida risk/TPN/immunocompromised: consider Micafungin

  • Repeat blood cultures q24–48h until clearance

  • Follow speciation/susceptibilities and narrow quickly

  • Evaluate/remove source:

    • Remove central line if S. aureus, Candida, Pseudomonas, tunnel infection, port pocket infection, septic thrombosis, persistent bacteremia

    • Consider line salvage only if uncomplicated CoNS and limited access

  • TTE/TEE if S. aureus bacteremia, persistent bacteremia, prosthetic valve/device, murmur, embolic signs

  • Trend CBC/CMP/fever curve/hemodynamics

  • ID consult if S. aureus, Candida, persistent bacteremia, MDR organism, endocarditis concern, retained hardware

  • Duration:

    • Uncomplicated CoNS: ~5–7 days if line removed

    • Gram negative uncomplicated: ~7–14 days

    • S. aureus: minimum 14 days from negative cultures if truly uncomplicated; 4–6 weeks if complicated/endocarditis

    • Candida: usually 14 days after clearance + symptom resolution