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
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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
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