Suspected CRBSI in the outpatient dialysis unit

CRBSI: catheter-related bloodstream infection; ESI: exit-site infection; IV: intravenous; S. aureus: Staphylococcus aureus.
* CRBSI is suspected in a dialysis patient who receives dialysis via a hemodialysis catheter and who develops fevers, chills, and rigors. Refer to the UpToDate topic on clinical presentation and diagnosis of CRBSI for additional information regarding the clinical presentation and diagnostic process using blood cultures.
¶ For patients with a documented allergy to vancomycin, we suggest using daptomycin. Gentamicin may be used as an alternative to ceftazidime among patients with a documented severe allergy to penicillin and in situations where ceftazidime is not readily available.
Δ For information on dosing of systemic antibiotics and antibiotic lock therapy, refer to the UpToDate topic on treatment of CRBSI. We only administer antibiotic locks using vancomycin, ceftazidime, and cefazolin at our center. Some dialysis units may lack the capability of antibiotic locks. In such cases, systemic antimicrobial therapy alone can be administered until the catheter is replaced.
◊ Absence of symptoms in this context refers to those that led to the diagnosis of CRBSI (eg, fever, chills, rigors).
§ We do not rely on clinical improvement alone for patients with S. aureus and Candida infections. Instead, we wait for clearance of bacteremia with negative blood cultures before placing a new tunneled dialysis catheter.
¥ If initial blood cultures (collected before the first dose of antibiotics) are negative, then CRBSI is not present. Discontinue antibiotics.
‡ Patients with S. aureus bacteremia should be treated with antibiotics for a total of 4 weeks.
† Patients with bacteremia from S. aureus, Candida, pseudomonas, and other multi-drug resistant organisms should have their catheter removed rather than exchanged.