Preliminary reports suggest that after obtaining a bactericidal level of the antibiotic in the blood, stable asymptomatic patients without exit site or catheter tunnel tract involvement may be treated by changing the catheter over a guidewire plus a minimum of 3 weeks of systemic antibiotic therapy. Blood cultures should be repeated periodically during and immediately after this treatment to monitor its effectiveness. The catheter should also be removed in any clinically unstable patient. A new permanent access should not be placed until blood cultures, performed after cessation of antibiotic treatment, have been negative for at least 48 hours. Catheters associated with exit site infections alone can usually be salvaged without the need for catheter replacement.
Unstable patients require removal of the catheter for rapid response to therapy.
Most infections recurred as soon as the antibiotics were discontinued. In contrast, a preliminary study using catheter guidewire exchange in stable patients without tunnel involvement was able to salvage most catheters without apparent ill effects. The Work Group believes that 3 weeks of systemic antibiotic therapy are needed to treat catheter-associated bacteremia and that new permanent access should not be placed until cultures have been negative for at least 48 hours after cessation of antibiotic therapy.