CLABSI
System: Device-Associated Infections · Parent MOC: MOC - Diseases by System
Full name: Central Line–Associated Bloodstream Infection
One-Sentence Definition
Laboratory-confirmed bloodstream infection in a patient with a central venous catheter when the line is the likely source — a preventable device infection driven by skin flora and Biofilm.
Clinical Presentation
- Fever, chills, hemodynamic instability without another obvious source
- Exit-site erythema/pus sometimes absent (especially tunneled/port)
- Persistent bacteremia after “appropriate” drugs → biofilm / endocarditis / metastatic focus
Pathogens
| Frequency group | Organism | Notes |
|---|---|---|
| Common | CoNS (TBD), Staphylococcus aureus | Contaminant vs true — clinical judgment |
| GNR | Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa | ICU |
| Yeast | Candida spp. | Remove line; ophthalmology often |
Pathogenesis
- Hub contamination / skin insertion tract → intraluminal or extraluminal Biofilm
- Seeding to valves/bone → Infective Endocarditis · Acute Osteomyelitis
Diagnosis
| Step | Test | Note |
|---|---|---|
| Blood cultures | Paired peripheral + line (or differential time to positivity) | Before abx |
| Exit site | Culture if pus | |
| Echo | If S. aureus / Candida / persistent bacteremia | IE screen |
Surveillance definitions (NHSN) are epidemiologic — clinical decisions use ID judgment.
Treatment Principles
- Empiric cover Gram+ (± MRSA) and local GNR risks in unstable patients
- Catheter removal often required for S. aureus, Pseudomonas, Candida; salvage attempts only in selected CoNS/situations
- Duration depends on organism + complicated vs uncomplicated bacteremia
Prevention
- Insertion bundle (checklist, CHG, maximal barrier), daily necessity review, hub disinfection
- Prefer peripheral access when possible
Differential / Pitfalls
- Contaminant CoNS; secondary bacteremia from lung/urine/abdomen mislabeled as CLABSI
- Leaving an infected line in place with S. aureus
Learning Aids
Clinical Example
Example
Case: Port patient, fever; 2/2 cultures grow S. aureus.
Question: Line management?
Answer: Treat as complicated bloodstream infection — remove port/line in nearly all S. aureus CLABSI, echo, metastatic survey, AST-guided therapy. See Staphylococcus aureus · Sepsis.
Related
- Device-Associated Infections · Bloodstream and Sepsis · Biofilm
- Staphylococcus aureus · Figure - Bacterial Growth Curve
Active Recall
- Why is biofilm central to CLABSI persistence?
- Which organisms usually mandate line removal?
- What paired culture strategy helps prove line source?