Diagnosis and management of catheter-related bloodstream infections due to Staphylococcus aureus.

Intravenous catheters are essential to modern medical care but frequently cause complications, the most important of which is infection, commonly due to Staphylococcus aureus. It is estimated at least 3000 episodes of catheter-related bloodstream infection occur annually in Australia, and 9% to 25% of patients with such infections die. Infection rates vary depending on the type of device, with the lowest rates associated with peripherally inserted central catheters and highest rates with haemodialysis catheters. In febrile patients, the presence of an intravenous catheter should always prompt consideration of whether the line is the source, even if there is no exit site inflammation. If catheter-related infection appears likely, the line should be removed if possible. Either peripheral and line tip cultures, or timed cultures of blood drawn peripherally and through the line, should be taken. Empirical antibiotics should be aimed at S. aureus and aerobic Gram-negative organisms, and blood cultures should be repeated at 72 h. If S. aureus is grown, cure requires removal of the catheter, at least 14 days of parenteral therapy, and consideration of echocardiography (preferably transoesophageal). If the patient remains febrile for >72 h, blood cultures at 72 h grow S. aureus, or there is a prosthetic heart valve, the risk of endocarditis is high and 6 weeks of parenteral therapy should be given. Prevention requires an organized system of surveillance, with a strict policy on insertion of central lines in controlled conditions and regimented catheter care. The role of impregnated catheters in prevention remains controversial.