Bacteremia - Central Line Associated
Diagnosis & Contaminants

Diagnosis & Contaminants

Blood Cultures

  • 2 sets prior to antibiotics
  • AT LEAST one from peripheral site
  • If peripheral not possible obtain 2 or more sets through different catheter lumens
  • All catheter lumens should have at least an aerobic culture drawn
  • Port-a-cath must be accessed for culture prior to antibiotics
  • Catheters may be colonized with skin contaminants and should not be the sole source for blood cultures

Catheter-Related Cultures

  • Utility not well defined; should NOT routinely be obtained
  • If exudate is present, swab drainage and send for culture

Comments

Paired blood cultures from both peripheral and line growing the same organism supports CLABSI diagnosis

Often only line cultures are available; important to have multiple cultures from the line to help clarify contaminant vs true infection

Timed Collection Growth of microbes from the catheter sample at least 2 hours before growth detected in the peripheral blood sample best defines CLABSI.

Contaminants

Central lines are a foreign body; it is important to obtain multiple cultures from all lumens and peripheral cultures to determine true line infection vs contamination

Many organisms typically considered contaminants for non-line associated bacteremia may actually be responsible for a CLABSI

  • Coagulase negative Staphylococci (except S. lugdunensis)
  • Viridans group Streptococci
  • Micrococcus species
  • Aerococcus species
  • Corynebacterium species
  • Cutibacterium species
  • Bacillus (non-anthracis) species