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General Management of CRBSI
Hemodialysis Catheters
Organism-Specific Treatment
Pop & Lock
Potpouri
100
Empiric antibiotic coverage for MDR gram-negative rods should be use in these patient populations.
Who are neutropenic patients, patients severely ill with sepsis, and patients known to be colonized with MDR pathogens.
100
This is the preferred agent for the treatment of MSSA.
What is cefazolin.
100
The option of retaining long-term central venous catheters is an option when the infection is caused by which 2 organisms?
What are coag-negative staph and Enterococcus.
100
Antibiotic lock therapy is indicated in these patient populations.
Who are patients with CRBSI involving long-term catheters with no signs of exit site or tunnel infection for whom the goal is cath salvage.
100
This pathogen is the most common cause of CRBSIs.
What is coag-negative staph.
200
The guidelines specifically state that this antimicrobial agent should not be used for empiric therapy of CRBSI.
What is linezolid.
200
It is for this reason that it is important to avoid drawing blood from peripheral veins in this patient population.
What is the potential to injure veins.
200
This antibiotic class is the preferred class for CRBSIs caused by ESBL positive E coli or Klebsiella.
What is carbapenem.
200
This is the standard duration of therapy of antibiotic lock therapy according to the guidelines.
What is 7-14 days in conjunction with systemic therapy, dependent on the organism isolated. Will also accept duration of systemic antibiotics.
200
A set of blood cultures include these 2 things.
What are anaerobic and aerobic bottles.
300
Empiric therapy for suspected catheter-related Candidemia should be used in septic patients with these risk factors (name 4).
What are receiving TPN, prolonged use of broad-spectrum abx, heme malignancies, BMT or SOT, femoral cath, Candida colonization at multiple sites.
300
In patients whose symptoms resolve after 2-3 days of systemic antibiotic therapy, this option has been shown to have cure rates similar to catheter removal.
What is guidewire exchange of the catheter.
300
When a patient has negative peripheral blood cultures, but the culture drawn through the catheter is positive with this organism, the patient should be treated with systemic therapy for 5-7 days.
What is S. aureus.
300
According to the guidelines, antibiotic lock therapy can be given alone (without systemic abx therapy) in this scenario.
What is when patients have multiple positive cath-drawn blood cultures that grow coag negative staph or GNR and concurrent negative peripheral blood cultures and duration is 10-14 days.
300
Empiric antifungal coverage is not recommended in this patient population.
What is critically ill pediatric patients.
400
Describe the empiric therapy for critically-ill patients with femoral caths.
What is gram-pos pathogens, gram-neg rods, and Candida.
400
These are unique features of CRBSI in HD patients (name 5).
See Table 7 (page 28).
400
This antibiotic is not effective against E. faecalis.
What is quinupristin/dalfopristin.
400
This common lock ingredient has been shown to promote bacterial growth.
What is heparin.
400
These 3 techniques are the most reliable diagnostic methodoligies.
What are semiquantitative (roll plate) or quantitiative (luminal flushing or sonication methods).
500
This drug class is not recommended as adjunctive therapy in patients with CRBSI.
What is thrombolytic agents (B-I).
500
The risk to patients who only receive antibiotics for treatment of CRBSI.
What is 5x higher treatment failure.
500
In patients with CRBSI caused by S. aureus, these exceptions would qualify patients for 4-6 weeks of therapy (name 5).
What is DM, immunocompromised, infected catheter is NOT removed, pt has prosthetic material, evidence of endocarditis or suppurative thrombophlebitis, fever and bateremia do not resolve within 72 hours of start of therapy or evidence of metastatic infection.
500
When reconstituting daptomycin for antibiotic lock solution, this IV solution needs to be used.
What is Lactated Ringers.
500
This difference in time to positivity is considered indicative of a CRBSI.
What is the catheter blood culture resulting in a positive 2 hours prior to the peripheral blood culture.