Management of catheter-related bloodstream infection (CRBSI): Indications for catheter removal

In the setting of CRBSI, catheter removal (in addition to administration of systemic antimicrobial therapy) is warranted in the following circumstances, given the high likelihood of severe and/or progressive infection with antibiotic therapy alone:

Sepsis
Hemodynamic instability
Presence of concomitant endocarditis or evidence of metastatic infection
Presence of suppurative thrombophlebitis
Presence of a propagating clot
Persistent bacteremia after 72 hours of appropriate antimicrobial therapy
Subcutaneously tunneled central venous catheter tunnel tract infection or subcutaneous port reservoir infection

In addition, catheter removal is warranted in the setting of infection with the following pathogens, given the relatively high virulence and relatively low likelihood of treatment response with antibiotic therapy alone:

Staphylococcus aureus
Pseudomonas aeruginosa
Drug-resistant gram-negative bacilli
Candida spp

Refer to the UpToDate topic on treatment of CRBSI for further discussion.

Graphic 122402 Version 1.0

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Management of catheter-related bloodstream infection (CRBSI): Indications for catheter removal