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Cited by 1,449Central Venous Catheters and HemodialysisInfective Endocarditis Diagnosis and ManagementAntifungal resistance and susceptibility

Guidelines for the management of intravascular catheter-related infections

Mermel, Leonard A., Farr, Barry M., Sherertz, Robert J., Raad, Issam I., O'Grady, Naomi, Harris, JoAnn S., Craven, Donald E.·2001·Clinical Infectious Diseases
DOI 10.1086/320001
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Abstract

These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications. Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci, Staphylococcus aureus, aerobic gram-negative bacilli, and Candida albicans most commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical i.v. antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen(s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed. For management of bacteremia and fungemia from a tunneled catheter or implantable device, such as a port, the decision to remove the catheter or device should be based on the severity of the patient's illness, documentation that the vascular-access device is infected, assessment of the specific pathogen involved, and presence of complications, such as endocarditis, septic thrombosis, tunnel infection, or metastatic seeding. When a catheter-related infection is documented and a specific pathogen is identified, systemic antimicrobial therapy should be narrowed and consideration given for antibiotic lock therapy, if the CVC or implantable device is not removed. These guidelines address the issues related to the management of catheter-related bacteremia and associated complications. Separate guidelines will address specific issues related to the prevention of catheter-related infections. Performance indicators for the management of catheter-related infection are included at the end of the document. Because the pathogenesis of catheter-related infections is complicated, the virulence of the pathogens is variable, and the host factors have not been well defined, there is a notable absence of compelling clinical data to make firm recommendations for an individual patient. Therefore, the recommendations in these guidelines are intended to support, and not replace, good clinical judgment. Also, a section on selected, unresolved clinical issues that require further study and research has been included. There is an urgent need for large, well-designed clinical studies to delineate management strategies more effectively, which will improve clinical outcomes and save precious health care resources.

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Crossref · 10.1086/320001

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  • Venous catheter infection and IC guidelines, including the current IDSA guidelines, recommend removal of any intravascular catheter that is positive for a fungal pathogen (i.e., Candida) based on evidence from large retrospective and observational studies.

    “Venous catheter infection and IC guidelines, including the current IDSA guidelines, recommend removal of any intravascular catheter that is positive for a fungal pathogen (ie, Candida) based on evidence from large retrospective and observational studies.”

    From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [171]

  • Antimicrobial lock therapy has been proposed as an alternative strategy for the prevention and treatment of microbial biofilms, particularly for catheter-related bloodstream infections.

    “Antimicrobial lock therapy has been proposed as an alternative strategy for the prevention and treatment of microbial biofilms, particularly for catheter-related bloodstream infections [2,3].”

    From In vitro analysis of flufenamic acid activity against Candida albicans biofilms (2014) · cites this paper as [2]

  • Candida albicans forms biofilms on catheters and medical devices, which may be impossible to cure unless the device is removed.

    “Candida albicans also forms biofilms on catheters and medical devices, which may be impossible to cure unless the device is removed [1,2].”

    From In vitro analysis of flufenamic acid activity against Candida albicans biofilms (2014) · cites this paper as [2]

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Authors
Mermel, L. A., Farr, B. M., Sherertz, R. J., Raad, I. I., O'Grady, N., Harris, J. S., & Craven, D. E.
Affiliations
  • Brown University (US)
  • University of Virginia Health System (US)
  • Wake Forest University Health Sciences (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
  • Section of Pediatric Infectious Diseases, Boston University School of Medicine, Boston Medical Center, Boston
  • Boston University (US)
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2001-05-01
Volume
32
Issue
9
Pages
1249-1272
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1086/320001
OpenAlex
W2104851340
Cited by
1,449
References
219
Citations by year
2026: 8 · 2025: 19 · 2024: 20 · 2023: 9 · 2022: 14 · 2021: 16 · 2020: 20 · 2019: 29 · 2018: 38 · 2017: 24 · 2016: 40 · 2015: 39 · 2014: 54 · 2013: 56 · 2012: 72
FWCI
140.39
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Keywords
catheter-related infection, catheter-related bacteremia, central venous catheters, implantable venous access devices, pulmonary artery catheter, coagulase-negative staphylococci, Staphylococcus aureus, Candida albicans, empirical antimicrobial therapy, catheter removal, antibiotic lock therapy, septic thrombosis, endocarditis, metastatic seeding, tunnel infection, performance indicators, intensive care
MeSH terms
Anti-Infective Agents, Catheterization, Central Venous, Catheterization, Peripheral, Catheters, Indwelling, Cross Infection, Equipment Contamination, Humans, Fungemia, Bacteremia, Evidence-Based Medicine

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