IDSA’s updated guideline for the diagnosis and management of intravascular catheter-related infection will appear in the July 1 issue of Clinical Infectious Diseases and is now available online. The update addresses diagnostic issues, when to remove a catheter, and indications for initiating antimicrobial therapy. Organized to address specific clinical questions, the guideline includes algorithms to help manage patients with suspected or proven intravascular catheter infections. Performance measures are listed to assist in monitoring clinical practice. 

“This revised guideline will assist clinicians in their thoughtful and pragmatic management of patients with intravascular catheter-related infections,” said Leonard Mermel, DO, FIDSA and lead author of the guideline.  “Despite the density of the document, the revised figures and tables in particular will assist clinicians in quickly addressing management issues in an effort to optimize the care of patients with these complex infections.”

Several sections have been extensively revised, particularly those dealing with these infections in patients receiving hemodialysis through a catheter, pediatric patients, and patients with long-term catheters in whom catheter salvage is attempted using antibiotic lock therapy. Separate figures and tables are devoted to these patients and their unique management issues, as well as dosage recommendations for antibiotic lock therapy.

Despite the attention drawn to such serious and costly infections more than 30 years ago by Dennis Maki, MD, FIDSA and others, many unanswered questions remain for clinicians who manage patients with such infections, such as: 

• What is the additional benefit and optimal duration of antimicrobial lock therapy?
• How should patients with positive blood cultures drawn through catheters but with negative percutaneously-drawn cultures be managed?
• What is the optimal duration of systemic antibiotics for catheter-related bloodstream infections when catheters are kept in place or removed?

All of these questions underscore the high importance of prevention, and Dr. Mermel, professor of medicine at the Warren Alpert Medical School of Brown University and medical director in the department of epidemiology & infection control at Rhode Island Hospital, reports that an updated guideline related to prevention is in the works. Additionally, he says, clinical trials are sorely needed to address the unresolved management issues and to further improve the care of patients with these infections.

The guideline is available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our website. 

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